Beta-Blockers After Heart Surgery Show Double Benefits

Beta-blockers should be used as a first-line medication to prevent postoperative atrial fibrillation, a common complication of heart surgery, researchers report in today's rapid access issue of Circulation: Journal of the American Heart Association.

Researchers found that beta-blockers used in patients undergoing heart surgery decreased the incidence of post-operative atrial fibrillation (AF) and shortened hospital stay.

Atrial fibrillation occurs when the two small upper chambers of the heart (the atria) quiver instead of beating effectively. Blood isn't pumped completely out of them, so it may pool and clot. If a piece of a clot leaves the heart and lodges in an artery leading to the brain, a stroke results.

"Postoperative AF occurs in 25 percent to 40 percent of patients. Many studies have evaluated ways to decrease AF, however, none of these trials have been strong enough to show an effect on length of hospital stay or stroke," says Eugene Crystal, M.D., of the Arrhythmia Service, Hamilton General Hospital, Ontario, Canada.

Researchers reviewed evidence from 52 randomized trials of drugs or treatments to prevent AF. These drugs included amiodarone (an anti-arrhythmic drug), beta-blockers and sotalol -- a beta-blocker analyzed separately because of potential pro-arrhythmic side effects. Beta-blockers are used to treat high blood pressure and also reduce heart rate.

Researchers found that the efficacy of these drugs was similar. There was a slight benefit of sotalol and amiodarone in preventing AF. But these two drugs have some complications that may offset their advantages.

On the plus side, the researchers found that all three drugs reduced the length of hospital stay by about half a day.

"Reduction in length of stay by a simple, inexpensive therapy such as a beta-blocker can lead to a significant cost savings," Crystal says.

Crystal's co-authors are Stuart J. Connolly, M.D.; Khaled Sleik, M.D.; Tracy J. Ginger, M.D.; and Salim Yusuf, M.D.