Background:
Postoperative atrial fibrillation (POAF) is a common complication, and landiolol, an ultra-short acting beta-blocker, has been used to treat POAF in Japan. In this study, we investigated the efficacy and safety of landiolol for patients with POAF after cardiac surgery. Furthermore, since there were many cases of POAF recurrence in this study, we have also reported on the prediction factors for recurrence.
Methods:
This retrospective study was conducted between January 2014 and September 2016. The study included post-cardiac surgery patients who received landiolol for POAF in the intensive care unit. We first investigated the following parameters to assess the actual situation, efficacy, and safety of landiolol administration. These included systolic blood pressure (SBP), cardiac index (CI), and landiolol doses at the start of administration (T0) and the POAF improvement (TI). The recurrence rate of POAF were also investigated. We next investigated whether CHADS2 (C2) and CHA2DS2-VASc (C2V) scores are useful as predictors of POAF recurrence.
Results:
1) Of 19 eligible patients with POAF after cardiac surgery, 18 patients (94.7%) showed POAF improvement. In these patients, landiolol was administered 1.5[0.7-2.3] (mean [interquartile range]) mcg/kg/min at T0 and 2.1[1.4-3.0] mcg/kg/min at TI. SBP was 115[101-131]mmHg at T0 and 103[87-115]mmHg at TI, CI was 3.0[2.0-4.2] L/min/m2 at T0 and 3.0[2.6-3.9] L/min/m2 at TI, and there was no significant difference in either parameter.
2) To investigate the predictors of POAF recurrence, the 18 cases in which landiolol was effective were divided into a recurrent group (Rc, N=10) and a non-recurrent group (Nrc, N=8). C2 was 2.0[1-3] in the Nrc group and 3.5[2-4] in the Rc group, and was significantly different (p=0.04). C2V was 3.5[3-4.75] in the Nrc group and 5.5[3-6] in the Rc group (p=0.07).
Discussion:
This study showed that landiolol is effective for POAF without circulatory suppression. And we also examined the predictors of recurrence. Our results strongly suggest an association between POAF recurrence and "C2 score". This study is the first report to show that the C2 score can predict POAF recurrence after landiolol administration. Therefore, our results suggests that C2 may be used to evaluate the necessity of measures to prevent POAF recurrence. Moreover, from the viewpoint of simplification of management and medical economy, it can aid in predicting the appropriate withdrawal timing of landiolol.


12 / Clinical features and factors for recurrence of patients receiving landiolol for atrial fibrillation after cardiac surgery.