Metoprolol versus low-dose sotalol for prevention of high-risk post coronary artery bypass grafting atrial fibrillation

Yasser Metwally; Ashraf Mahmoud; Walid  Taha

doi:10.35810/ects.v3i2.179

Yasser Metwally Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Ashraf Mahmoud Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Walid Taha Department of Anesthesiology, Faculty of Medicine, Cairo University, Cairo, Egypt

DOI: https://doi.org/10.35810/ects.v3i2.179

Keywords: Low-dose sotalol, Metoprolol, CABG, POAF, High-risk mitral valve replacement

Abstract

Background: The optimal therapeutic strategy for high-risk postoperative atrial fibrillation (POAF) remains less well defined. Our objectives were to investigate the efficacy of prophylactic metoprolol versus low-dose sotalol regimens to prevent high-risk atrial fibrillation (AF) following coronary artery bypass surgery (CABG).

Methods: We assigned 113 consecutive patients referred for CABG to either metoprolol or low-dose sotalol regimen. The primary end-point was the frequency of POAF during the 6-week follow-up.

Results: Out of 113 patients enrolled, 52.2% % received metoprolol (n= 59) while 44.8% received sotalol (n= 54). The frequency of POAF at follow-up was significantly higher among the metoprolol group (59.3 % versus 50 %; P=0.017). The predictors of POAF were: age > 60 years (OR: 1.86 (1.01-4.41); P= 0.03), EF (OR: 2 (1.05-3.83); P= 0.02), and sotalol was protective against POAF (OR= 0.49%; (95% CI=0.25 -0.97); P=0.02). The length of hospital stay was significantly higher in the metoprolol group (7.5±1.3 % versus 6.1±1.2 days; P<0.001).

Conclusion: Prophylactic low-dose sotalol could be superior to metoprolol for the prophylaxis of POAF in high-risk patients. However, Larger prospective multicenter randomized trials are needed to confirm our findings.