A STUDY ON CARVEDILOL VERSUS METOPROLOL IN THE MANAGEMENT OF ATRIAL FIBRILLATION IN POST OPERATIVE CORONARY ARTERY BYPASS GRAFT SURGERY PATIENTS
Abstract
The objective of the present study is to analyse the effectiveness of carvedilol and metoprolol in the management of atrial fibrillation in post operative coronary artery bypass graft surgery patients. Atrial fibrillation occurs frequently soon after coronary artery bypass grafting and often results in increased mortality and morbidity. The incidence of post operative atrial fibrillation actually varies from 11% to 40% despite of the surgical technique and current guidelines recommend beta blockers as a medication for the prevention of atrial fibrillation after coronary artery bypass graft surgery. A prospective observational study was conducted on 100 subjects considering the inclusion and exclusion criteria and they were classified into carvedilol and metoprolol group. Heart rate was chosen as the primary parameter and statistical analysis was performed using student‘t’ test (p<0.05). There was a statistically significant decrease in the heart rate after therapy for both metoprolol and carvedilol but the difference in the effectiveness between carvedilol and metoprolol could not be significantly identified.
Keywords:
Post Operative Atrial Fibrillation, Coronary Artery Bypass Graft Surgery, Metoprolol, Carvedilol, Heart Rate.DOI
https://doi.org/10.25004/IJPSDR.2018.100410References
Ismail MF, El-mahrouk AF, Hamouda TH, Radwan H, Haneef A, Jamjoom AA . Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience. Journal of Cardiothoracic Surgery. 2017; 12:40.
Acikel S, Bozbas H, Gultekin B, Aydinalp A, Saritas B, Bal U, Yildirir A, Muderrisoglu H, Sezgin A, Ozin B. Comparison of the efficacy of Metoprolol and Carvedilol for preventing fibrillation after coronary bypass surgery. International Journal of Cardiology. 2008; 126: 108-113.
Haghjoo M. Pharmacological and Non pharmacological Prevention of Atrial Fibrillation after Coronary Artery Bypass Surgery. The Journal of Tehran University Heart Center. 2012; 7: 2-9.
Jalalian R, Ghafari R, Ghazanfari P. Comparing the Therapeutic Effects of Carvedilol and Metoprolol on Prevention of Atrial Fibrillation after Coronary Artery Bypass Surgery, a Double-Blind Study. International Cardiovascular Research Journal. 2014; 8: 111-115.
Marazzi G, Iellamo F, Volterrani M , Caminiti G, Madonna MD, Giovanna Arisi M, Massaro R , Righi D, Rosano G MC. Comparison of Effectiveness of Carvedilol Versus Bisoprolol for prevention of post discharge atrial Fibrillation After Coronary Bypass Grafting in Patients With Heart Failure. The American Journal of Cardiology. 2011; 107: 215-219.
Attaran S, Shaw M, Bond L, Pullan MD, Fabri BM. Atrial fibrillation post cardiac surgery: a common but a morbid complication. Interactive CardioVascular and Thoracic Surgery, 2011; 12: 772–777.
DiNicolantonio JJ, Beavers CJ, Menezes AR, Lavie CJ, O'Keefe JH, Meier P, Vorobcsuk A, Aradi D, Komócsi A, Chatterjee S, D'Ascenzo F, Gasparini M, Brugts J, Biondi-Zoccai G. Meta-Analysis Comparing Carvedilol Versus Metoprolol for the Prevention of Postoperative Atrial Fibrillation Following Coronary Bypass Grafting. American Journal of Cardiology. 2014; 113: 565-569.
Wang HS, Wang ZW, Yin ZT. A study on Carvedilol for prevention of Atrial Fibrillation after Cardiac Surgery: A Meta Analysis. PLOS ONE.2014; 9: 1-7.
Haghjoo M, Saravi M, Hashemi MJ, Hosseini S, Givtaj N, Ghafarinejad MH, Khamoushi AJ, Emkanjoo Z, Fazelifar AF, Alizadeh A, Sadr-Ameli MA. Optimal beta blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: Carvedilol versus Metoprolol. Heart Rhythm. 2007; 4:1170-1179.
Lúcio Ede A, Flores A, Blacher C, Leães PE, Lucchese FA, Ribeiro JP. Effectiveness of Metoprolol in Preventing atrial Fibrillation and Flutter in the Postoperative Period of Coronary Artery Bypass Graft Surgery. Arq Bras cardiol. 2004; 82: 42-46.
Khan MF, Wendel CS, Movahed MR. Prevention of post–Coronary Artery Bypass Grafting (CABG) Atrial Fibrillation: Efficacy of prophylactic beta-blockers in the modern era: A meta-analysis of latest randomized controlled trials.Annals of NonInvasive Electrocardiology. 2013; 18: 58-68.
Celik T, Iyisoy A, Jata B, Celik M, Gunay C, Isik E. Beta blockers for the prevention of atrial fibrillation after coronary artery bypass surgery: carvedilol versus metoprolol. International Journal of Cardiology, 2009; 135: 393-396
Mayson SE1, Greenspon AJ, Adams S, Decaro MV, Sheth M, Weitz HH, Whellan DJ. The Changing Face of Postoperative Atrial Fibrillation Prevention: A Review of Current Medical Therapy. Cardiology In Review. 2007; 15: 231-241.
Inoue H, Atarashi H, Okumura K, Yamashita T, Fukuzawa M, Shiosakai K, Kimura T. Heart rate control by carvedilol in Japanese patients with chronic atrial fibrillation: The AF Carvedilol study. Journal of Cardiology. 2017; 69: 293-301.
Metra M, Torp-Pedersen C, Swedberg K, Cleland JG, Di Lenarda A, Komajda M, Remme WJ, Lutiger B, Scherhag A, Lukas MA, Charlesworth A, Poole-Wilson PA. Influence of heart rate, blood pressure, and beta-blocker dose on outcome and the differences in outcome between carvedilol and metoprolol tartrate in patients with chronic heart failure: Results from the COMET trial. European Heart Journal. 2005; 26: 2259– 2268.
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