2021 Volume 27 Issue 1 Pages 27-32
Objective: Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG) even if off-pump procedure is used. Although β-blockers or atrial pacing have been reported to be effective for the prevention of postoperative AF, the efficacy of combination with β-blockers and atrial pacing is still controversial. The purpose of this study was to elucidate the effect of intravenous landiolol infusion with temporary right atrial pacing on the prevention of AF after off-pump CABG. Methods: A prospective observational study was designed to compare 28 consecutive patients who were administered landiolol combined with temporary right atrial pacing to 24 consecutive patients who received landiolol without pacing. All patients received landiolol intravenously to maintain their heart rate at 60-80 bpm immediately after surgery until oral carvedilol intake. Atrial pacing was commenced at a rate of approximately 90 bpm and the dose of landiolol was reduced while ensuring that the intrinsic heart rate did not exceed the pacing rate. The primary endpoint was the incidence of AF. Results: The incidence of postoperative AF in both groups was not different (17.9% vs.12.4% respectively, p=0.602). The dose of landiolol in patients with pacing was significantly lower compared to those without pacing (4.0 γ vs. 6.4 γ respectively, p < 0.05). Conclusions: Temporary right atrial pacing did not have an additive effect on landiolol to prevent the incidence of AF after off-pump CABG. On the other hand, it enabled a reduction in landiolol dose, which might contribute to reducing any adverse effects caused by landiolol.
