Intraoperative Infusion of Landiolol Hydrochloride, an Ultra-Short Acting Beta-1 Adrenergic Receptor Blocker, Prevents Postoperative Atrial Fibrillation After Off-Pump Coronary Artery Bypass Surgery

Abstract

PURPOSE: Postoperative atrial fibrillation (AF) is associated with adverse effects after coronary artery bypass surgery. The aim of this study was to evaluate the effect of intraoperative infusion of landiolol hydrochloride, a novel ultra-short acting beta-1 adrenergic receptor blocker, for post-operative AF after off-pump coronary artery bypass (OPCAB) surgery. METHODS: One hundred forty patients who underwent OPCAB were analyzed retrospectively. Landiolol group (Group L: n=68) was compared with control group (Group C: n=72). In group L, landiolol was infused after sternotomy, starting at 1 (mu)g/kg/min. The dose was increased as long as the systolic pressure was maintained above 100 mmHg. The infusion was continued until the end of the day of surgery. RESULTS: Average age (years) in both groups was similar (70(plus or minus)9 in group C vs. 67(plus or minus)7 in group L; P=0.254). The average maximum dose of landiolol was 4.7(mu)g/ kg/min. Systolic blood pressure (mmHg) at the left anterior descending artery anastomosis were similar (109(plus or minus)17 vs. 108(plus or minus)8, P=0.740). Heart rate (beats/minute) was significantly decreased in group L (80(plus or minus)14 vs. 65(plus or minus)10; P=0.003). Profound hypotension/bradycardia were not observed during OPCAB. Postoperatively, AF was observed in 25 patients (34.7%) in group C and 12 patients (17.6%) in group L (P=0.022). Postoperative stroke was noticed in 2 patient (2.9%) in group C, and zero in group L (P=0.313). More than three anti-AF agents were needed in 11 patients (44% of AF patients) in group C, while one (8%) in group L (P = 0.030). AF lengthened more than 24 hours was observed in 7 patients (28%) in group C, while no patient in group L (P = 0.041). CONCLUSIONS: Intra-operative infusion of landiolol hydrochloride decreased the incidence of postoperative AF after OPCAB surgery. This regimen was also associated with early conversion of postoperative AF to sinus rhythm. CLINICAL IMPLICATIONS: Intraoperative landiolol infusion is safe, and may improve the results of OPCAB by preventing postoperative AF.