Oral d,l sotalol reduces the incidence of postoperative atrial fibrillation in coronary artery bypass surgery patients: A randomized, double-blind, placebo-controlled study

OBJECTIVES The purpose of this prospective, randomized, double-blind, place bo-controlled study was to assess the efficacy of preoperatively and postop eratively administered oral d,l sotalol in preventing the occurrence of pos toperative atrial fibrillation (AF). BACKGROUND Atrial fibrillation is the most common arrhythmia following coro nary artery bypass surgery (CABG). Its etiology, prevention and treatment r emain highly controversial. Furthermore, its associated morbidity results i n a prolongation of the length of hospital stay post-CABG. METHODS A total of 85 patients, of which 73 were to undergo CABG and 12 CAB G plus valvular surgery (ejection fraction greater than or equal to 28% and absence of clinical heart failure), were randomized to receive either sota lol (40 patients; mean dose = 190 +/- 43 mg/day) started 24 to 48 h before open heart surgery and continued for four days postoperatively, or placebo (45 patients, mean dose = 176 +/- 32 mg/day). RESULTS Atrial fibrillation occurred in a total of 22/85 (26%) patients. Th e incidence of postoperative AF was significantly (p = 0.008) lower in pati ents on sotalol (12.5%) as compared with placebo (38%). Significant bradyca rdia/hypotension, necessitating drug withdrawal, occurred in 2 of 40 (5%) p atients on sotalol and none in the placebo group (p = 0.2). None of the pat ients on sotalol developed Torsade de pointes or sustained ventricular arrh ythmias. Postoperative mortality was not significantly different in sotalol versus placebo (0% vs. 2%, p = 1.0). Patients in the sotalol group had a n onsignificantly shorter length of hospital stay as compared with placebo (7 +/- 2 days vs. 8 +/- 4 days; p = 0.24). CONCLUSIONS The administration of sotalol, in dosages ranging from 80 to 12 0 mg, was associated with a significant-decrease (67%) in postoperative AF in patients undergoing CABG without appreciable side effects. Sotalol shoul d be considered for the prevention of postoperative AF in patients undergoi ng CABG in the absence of heart failure and significant left ventricular dy sfunction. (C) 1999 by the American College of Cardiology.