Selective versus non-selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery : is there a need for pre-operative risk stratification? A prospective placebo-controlled study using low-dose sotalol

• Published in: European heart journal 1998-05, Vol.19 (5), p.794-800
• Main Authors: WEBER, U. K, OSSWALD, S, HUBER, M, BUSER, P, SKARVAN, K, STULZ, P, SCHMIDHAUSER, C, PFISTERER, M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Algorithms; Anti-Arrhythmia Agents - administration & dosage; Anti-Arrhythmia Agents - adverse effects; Atrial Fibrillation - diagnosis; Atrial Fibrillation - prevention & control; Biological and medical sciences; Coronary Artery Bypass; Dose-Response Relationship, Drug; Double-Blind Method; Electrocardiography - drug effects; Female; Humans; Male; Medical sciences; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - prevention & control; Prospective Studies; Risk Assessment; Sotalol - administration & dosage; Sotalol - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1053/euhj.1997.0838

This study evaluated the advantages of 'selective' over 'non-selective' antiarrhythmic prevention of atrial fibrillation after coronary surgery based on a new risk prediction algorithm. In a retrospective analysis of a prospective randomized trial, a model for risk prediction was determined based on clinical data of the control group (A; n = 107) and tested in a test group (B; n = 107, treated with low dose sotalol). Using this algorithm, the effect of a 'selective' antiarrhythmic approach in high-risk patients was compared to a 'non-selective' approach, where all patients were treated. In total, 75 (35%) patients developed atrial fibrillation and 14 (7%) side-effects led to discontinuation of study medication. Based on the risk prediction algorithm, 36% of group A patients were classified as high-risk patients with an incidence of atrial fibrillation of 76% compared to 26% in low-risk patients (P < 0.0001). The selective approach, i.e. treatment of high-risk patients only reduced the incidence of atrial fibrillation from 76% to 50% (P = 0.0295) compared to a reduction from 44% to 26% (P = 0.0065) when all patients were treated. More importantly, with the non-selective approach 100% of patients were exposed to the possible side-effects of sotalol and costs compared to 24% only with the selective approach (P < 0.0001). Thus, a selective approach based on a clinical risk prediction algorithm should improve the cost-effectiveness and safety of low-dose sotalol in the prevention of atrial fibrillation after coronary bypass surgery.