An. Mooss et al., Esmolol versus diltiazem in the treatment of postoperative atrial fibrillation/atrial flutter after open heart surgery, AM HEART J, 140(1), 2000, pp. 176
Citations number
23
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background Supraventricular tachyarrhythmias are common after open heart su
rgery. Possible causative factors for these arrhythmias include operative t
rauma, atrial ischemia, electrolyte imbalances, pericardial irritation, and
excess catecholamines. Two agents commonly used to control ventricular rat
e in atrial fibrillation or atrial flutter (AF/AFL) are beta-blockers and c
alcium channel blockers.
Methods and Results This randomized study was designed to compare the safet
y and efficacy of intravenous diltiazem versus intravenous esmolol in patie
nts with postoperative AF/AFL after coronary bypass surgery and/or valve re
placement surgery. A comparative cost analysis was also performed. Thirty p
atients received either esmolol (n = 15) or diltiazem (n = 15) for AF/AFL.
During the first 6 hours of treatment, 66.6% of esmolol-treated patients co
nverted to sinus rhythm compared with 13.3% of the diltiazem-treated patien
ts (P < .05). At 24 hours, 66.6% of the diltiazem group converted to SR com
pared with 80% of the esmolol group (not significant). Drug-induced side ef
fects, time to rate control (<90 beats/min), number of patients requiring c
ardioversion, and length of hospitalization were similar for the two groups
. The drug cost/successfully treated patient for esmolol versus diltiazem w
as $254 versus $437 at 6 hours and $529 versus $262 at 24 hours.
Conclusions Although this is a small study, it suggests that esmolol is mor
e effective in converting patients to normal sinus rhythm than diltiazem du
ring the initial dosing period. No differences in conversion rates were obs
erved between the two groups after 24 hours. Additional studies are needed
to confirm whether esmolol is the initial drug of choice in patients with p
ostoperative AF/AFL after coronary bypass surgery.