Aa. Bert et al., A beta-blocker, not magnesium, is effective prophylaxis for atrial tachyarrhythmias after coronary artery bypass graft surgery, J CARDIOTHO, 15(2), 2001, pp. 204-209
Objective: To evaluate magnesium as a sole or adjuvant agent with currently
used prophylactic drugs in suppressing postoperative atrial tachyarrhythmi
as (POAT) after coronary artery bypass graft (CABG) surgery.
Design: Single-center prospective, randomized clinical trial.
Setting: University hospital.
Participants: Patients (n = 400) undergoing CABG surgery. interventions: Pa
tients were randomized among 6 prophylaxis regimens: (1) control (no antiar
rhythmics), (2) magnesium only, (3) digoxin only, (4) magnesium and digoxin
, (5) propranolol only, and (6) magnesium and propranolol. Patients randomi
zed to a regimen including magnesium received 12 g given during 96 hours po
stoperatively. Patients in a digoxin regimen received 1 mg after cardiopulm
onary bypass and 0.25 mg daily. Patients in a propranolol regimen received
1 mg intravenously every 6 hours until able to take 10 mg orally 4 times a
day. Prophylaxis regimens were discontinued after 4 days postoperatively.
Measurements and Main Results: The primary outcome was a sustained POAT or
discharge from the hospital. Control patients had an incidence of POAT (38%
) not significantly different from patients in magnesium-only (38%), digoxi
n-only (31%), and magnesium with digoxin (37%) regimens. Patients treated w
ith propranolol had a significant reduction in POAT. Nearly identical POAT
rates in the propranolol-only (18%) and propranolol with magnesium (19%) gr
oups support the lack of efficacy of magnesium in this trial. Study design
allowed analysis of and showed a beta -blocker withdrawal effect in additio
n to suppressive benefit of postoperative beta -blockers.
Conclusion: beta -Blocker prophylaxis is indicated to reduce the incidence
of POAT in CABG surgery patients and to prevent a beta -blocker withdrawal
effect in patients receiving these medications preoperatively. Digoxin and
magnesium as sole or adjuvant agents do not offer suppressive or ventricula
r rate reduction benefits in POAT. Copyright (C) 2001 by W.B. Saunders Comp
any.