RESUMO
BACKGROUND: Supraventricular tachyarrhythmia (SVT) commonly occurs shortly after coronary artery bypass grafting (CABG), but ventricular arrhythmias are less documented. METHODS: On the 1st postoperative day, 206 consecutive eligible patients were prospectively randomized to a sotalol group (80 mg b.i.d.; n = 103) or a control group without beta-blockade or antiarrhythmic drugs (n = 103). RESULTS: The SVT incidence (predominantly atrial fibrillation) accounted for 16% in the sotalol group versus 48% (p < 0.00001). Multivariate analysis showed that sotalol reduced the SVT incidence (p < 0.00001, odds ratio, 0.20; 95% confidence interval, 0.09 to 0.42), whereas a lower preoperative left ventricular ejection fraction (p = 0.019) and older age (p = 0.031) were independent risk factors of SVT occurrence. The Holter electrocardiographic analysis (24 hours) demonstrated that sotalol (32 versus 92; p = 0.031) decreased the median number of ventricular events, mostly isolated premature ventricular beats. Neither ventricular proarrhythmia effect nor "torsades de pointes" were detected. Despite strict hemodynamic-based selection, sotalol had to be discontinued in 8 patients (7.8%), for reasons related to asthma in 3 or cardiac reasons in 5. CONCLUSIONS: Oral low-dose sotalol provided considerable and reliable protection in selected nondepressed cardiac function patients, reducing the occurrence of both supraventricular and ventricular arrhythmias after CABG.
Assuntos
Antiarrítmicos/administração & dosagem , Ponte de Artéria Coronária/efeitos adversos , Sotalol/administração & dosagem , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/prevenção & controle , Administração Oral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Taquicardia Ventricular/epidemiologiaRESUMO
BACKGROUND: A method of cold blood cardioplegia (CBCP) delivered continuously and in a retrograde manner was compared with methods differing only by their rate (intermittent) or way (antegrade) of administration. METHODS: This study comprises 298 consecutive patients undergoing isolated coronary artery bypass grafting procedures performed by the same surgeon from 1992 to 1995. Three-vessel disease characterized 58.8% of the cases, and the left ventricular ejection fraction was less than 0.40 in 22.8%. In group I (n = 100), CBCP was administered in an antegrade and intermittent fashion; in group II (n = 87), CBCP was given in a retrograde and intermittent manner; in group III (n = 111), CBCP delivery was retrograde and continuous. RESULTS: The incidence of major cardiac adverse outcome (death or need for intraaortic balloon counterpulsation) was 7.0% in group I, 8.0% in group II, and 0.9% in group III (p = 0.040). Repeated-measures analysis of hemodynamic indices showed a marked superiority of continuous retrograde compared with antegrade intermittent blood cardioplegia regarding left ventricular stroke work index (p < 10(-4)) and compared with both methods of intermittent CBCP regarding right ventricular stroke work index (p < 10(-5)). CONCLUSIONS: The use of continuous CBCP resulted in a significant reduction in major cardiac events, better left ventricular performance, and a marked improvement of right ventricular function in comparison with similar solutions of blood cardioplegia administered intermittently, independent of their way of delivery.