Efficacy of Low-dose Propranolol in Preventing Postoperative Supraventricular Tachyarrhythmias

Abstract

A prospective, randomized study was performed in 100 consecutive patients undergoing coronary artery bypass surgery to assess the efficacy of the early reinstitution of propranolol in reducing the incidence of postoperative supraventricular tachyarrhythmias (SVT). Patients were randomized to receive propranolol 10 mg every 6 h enterally starting the morning after surgery (group 1, 50 patients) or to serve as controls (group 2, 50 patients). No patient was excluded because of poor ventricular function, need for urgent revascularization, or transient necessity for ionotropic support. Both groups had a comparable incidence of risk factors, previous infarction, unstable angina and abnormal ventricular function. The extent of coronary disease, preoperative propranolol dose and number of grafts performed were similar. SVT occurred in 3/50 (6%) patients in group 1, compared with 14/50 (28%) in group 2 (P < 0.01). There were no preoperative or intraoperative discriminators to predict the occurrence of SVT. Perioperative infarction and the need for mechanical or pharmacologic circulatory support did not predispose to SVT. Evidently, early readministration of propranolol should be given to all patients after myocardial revascularization to decrease the incidence of these postoperative rhythm disturbances.