Preventive effect of low-dose landiolol on postoperative atrial fibrillation study (PELTA study)
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ORIGINAL ARTICLE
Preventive effect of low‑dose landiolol on postoperative atrial fibrillation study (PELTA study) Konosuke Sasaki1 · Kiichiro Kumagai2 · Kay Maeda1 · Masatoshi Akiyama1 · Koki Ito1 · Satoshi Matsuo1 · Shintaro Katahira1 · Tomoyuki Suzuki1 · Yusuke Suzuki1 · Yu Kaiho3 · Yumi Sugawara3 · Ichiro Tsuji3 · Yoshikatsu Saiki1,2 Received: 2 January 2020 / Accepted: 26 March 2020 © The Author(s) 2020
Abstract Objective To investigate the efficacy of prophylactic administration of low-dose landiolol on postoperative atrial fibrillation (POAF) in patients after cardiovascular surgery. Methods Consecutive 150 patients over 70 years of age who underwent cardiovascular surgery for valvular, ischemic heart, and aortic diseases were enrolled in this single-center prospective randomized control study from 2010 to 2014. They were assigned to three treatment groups: 1γ group (landiolol at 1 μg/kg/min), 2γ group (landiolol at 2 μg/kg/min), or control group (no landiolol). In the two landiolol groups, landiolol hydrochloride was intravenously administered for a period of 4 days postoperatively. Electrocardiography was continuously monitored during the study period, and cardiologists eventually assessed whether POAF occurred or not. Results POAF occurred in 24.4% of patients in the control group, 18.2% in 1γ group, and 11.1% in 2γ group (p = 0.256). Multivariate logistic regression analysis showed that the incidence of POAF tended to decrease depending on the dose of landiolol (trend-p = 0.120; 1γ group: OR = 0.786, 95% CI 0.257–2.404; 2γ group: OR = 0.379, 95% CI 0.112–1.287). Subgroup analysis showed a significant dose-dependent reduction in POAF among categories of female sex, non-use of angiotensin II receptor blockers (ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and 0.004). Conclusions These findings indicate that prophylactic administration of low-dose landiolol may not be effective for preventing the occurrence of POAF in overall patients after cardiovascular surgery, but the administration could be beneficial to female patients, patients not using ARBs preoperatively, and those after valvular surgery. Keywords Landiolol hydrochloride · Postoperative atrial fibrillation · Prophylactic administration · Low dose · Cardiovascular surgery
Introduction Konosuke Sasaki and Kiichiro Kumagai contributed equally to this manuscript. * Yoshikatsu Saiki [email protected] 1
Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1‑1 Seiryo‑machi, Aoba‑ku, Sendai 980‑8574, Japan
2
Research Division of Sciences for Aortic Disease, Tohoku University Graduate School of Medicine, Sendai, Japan
3
Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiovascular surgery. The incidence of POAF varies widely from approximately 18–64% [1, 2] and is greater a
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