Purpose: This prospective, randomized, open label study was designed to compare the efficacy of IV esmolol (IVE) vs. IV diltiazem (IVD) for the treatment of atrial fibrillation/flutter (AF/F) following coronary artery bypass and or valve replacement surgery (CABG/VRS).
Methods: Written informed consent was obtained before or as soon after surgery as possible. Of the patients randomized, thirty subjects developed AF/F post-op with a rapid ventricular rate [is greater than] 100 BPM and received IVE or IVD. Subjects were excluded if they had a contraindication to beta blockade. Drug was continuously infused for twenty four hours or until; patient reverted to normal sinus rhythm (NSR); an alternate drug was added; patient was cardioverted; or death. Patients were not excluded if given digoxin postoperative for rate control. Variables measured were: time to rate control, incidence of drug induced sideeffects, length of hospitalization, and percentage of patients that converted to NSR within 1, 2, 5, 6, 8, 10, 12, and 24 hrs. Significance was defined as a p value less than 0.05.
Results: Thirty patients received either IVE (15) or IVD (15) for AF/F based on study protocol. Pre- and postoperative characteristics were similar between the two groups. Similarities were observed for drug induced side effects, overall conversion rate, time to rate control ([is less than] 90 BPM), number of patients requring cardioversion, and length of hospitalization. Conversion rate for IVE was significantly better than for IVD during any time point within the first six hours(p [is less than] 0.05) after which time no differences were observed. The conversion rate within 24 hrs. was higher for IVE than IVD (80% vs. 66.6%).
Conclusion: IVE produced a faster and overall higher conversion rate than IVD for treating AF/F following CABG/VRS.
Clinical Implications: Postoperative SVT is a major problem after heart surgery, potentially leading to increased morbidity and ICU stay. IVE is well tolerated, induces rapid conversion, and has an overall higher conversion rate than IVD.
Aryan N Mooss, MD(*); S M Mohiuddin, MD; J T Sugimoto, MD; W Scott, MD; A P Reyes, MD; S Seyedroudbari, PharmD; D E Hilleman, PharmD and R L Wurdeman, PharmD. School of Medicine, Creighton University, Omaha, NE and Cardiothoraeic Surg., Saint Joseph Hospital, Omaha, NE.
COPYRIGHT 1999 American College of Chest Physicians
COPYRIGHT 2000 Gale Group
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