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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

Weber, U. Klöter ; Osswald, S. ; Huber, M. ; Buser, P. ; Skarvan, K. ; Stulz, P. ; Schmidhauser, C. ; Pfisterer, M.

In: European Heart Journal, 1998, vol. 19, no. 5, p. 794-800

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    Title
    • 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
    Author
    • Weber, U. Klöter. Division of Cardiology, Department of Internal Medicine, Department of Anesthesiology, Basel, Switzerland
    • Osswald, S.. Division of Cardiology, Department of Internal Medicine, Department of Anesthesiology, Basel, Switzerland
    • Huber, M.. Division of Cardiology, Department of Internal Medicine, Department of Anesthesiology, Basel, Switzerland
    • Buser, P.. Division of Cardiology, Department of Internal Medicine, Department of Anesthesiology, Basel, Switzerland
    • Skarvan, K.. Division of Cardiology, Department of Internal Medicine, Department of Anesthesiology, Basel, Switzerland
    • Stulz, P.. Clinic for Cardiothoracic Surgery, University Hospital, Basel, Switzerland
    • Schmidhauser, C.. Brunner and Hess, Statistics and Software Solutions Inc. Zurich, Switzerland
    • Pfisterer, M.. Division of Cardiology, Department of Internal Medicine, Department of Anesthesiology, Basel, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • European Heart Journal, 1998, vol. 19, no. 5, p. 794-800. Oxford University Press
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:293916
    Summary
    Aim 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. Methods and Results 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). Conclusions: 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