Prophylaxis of supraventricular and ventricular arrhythmias after coronaryartery bypass grafting with low-dose sotalol

Background. Supraventricular tachyarrhythmia (SVT) commonly occurs shortly after coronary artery bypass grafting (CABG), but ventricular arrhythmias a re less documented. Methods. On the Ist postoperative day, 206 consecutive eligible patients we re prospectively randomized to a sotalol group (80 mg b.i,d.; n = 103) or a control group without p-blockade or antiarrhythmic drugs (n = 103). Results. The SVT incidence (predominantly atrial fibrillation) accounted fo r 16% in the sotalol group versus 48% (p < 0.00001). Multivariate analysis showed that sotalol reduced the SVT incidence (p < 0.00001, odds ratio, 0.2 0; 95% confidence interval, 0.09 to 0.42), whereas a lower preoperative lef t ventricular ejection fraction (p = 0.019) and older age (p = 0.031) were independent risk factors of SVT occurrence. The Holter electrocardiographic analysis (24 hours) demonstrated that sotalol (32 versus 92; p = 0.031) de creased the median number of ventricular events, mostly isolated premature ventricular beats. Neither ventricular proarrhythmia effect nor "torsades d e pointes" were detected. Despite strict hemodynamic-based selection, sotal ol had to be discontinued in 8 patients (7.8%), for reasons related to asth ma in 3 or cardiac reasons in 5. Conclusions. Oral low-dose sotalol provided considerable and reliable prote ction in selected nondepressed cardiac function patients, reducing the occu rrence of both supraventricular and ventricular arrhythmias after CABG. (An n Thorac Surg 2000;70:151-6) (C) 2000 by The Society of Thoracic Surgeons.