Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1982 Aug;196(2):194–197. doi: 10.1097/00000658-198208000-00012

Efficacy of low-dose propranolol in preventing postoperative supraventricular tachyarrhythmias: a prospective, randomized study.

N A Silverman, R Wright, S Levitsky
PMCID: PMC1352475  PMID: 6979982

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 hours enterally starting the morning after surgery (Group I, 50 patients) or to serve as controls (Group II, 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 also similar. SVT occurred in 3/50 (6%) patients in Group I compared with 14/50 (28%) in Group II (p less than 0.01). There were no preoperative or intraoperative discriminators to predict the occurrence of SVT. In addition, perioperative infarction and the need for mechanical or pharmacologic circulatory support did not predispose to SVT. The data indicate that early administration of propranolol should be given to all patients after myocardial revascularization to decrease the incidence of these postoperative rhythm disturbances.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alderman E. L., Coltart D. J., Wettach G. E., Harrison D. C. Coronary artery syndromes after sudden propranolol withdrawal. Ann Intern Med. 1974 Nov;81(5):625–627. doi: 10.7326/0003-4819-81-5-625. [DOI] [PubMed] [Google Scholar]
  2. Angelini P., Feldman M. I., Lufschanowski R., Leachman R. D. Cardiac arrhythmias during and after heart surgery: diagnosis and management. Prog Cardiovasc Dis. 1974 Mar-Apr;16(5):469–495. doi: 10.1016/0033-0620(74)90007-3. [DOI] [PubMed] [Google Scholar]
  3. Boudoulas H., Snyder G. L., Lewis R. P., Kates R. E., Karayannacos P. E., Vasko J. S. Safety and rationale for continuation of propranolol therapy during coronary bypass operation. Ann Thorac Surg. 1978 Sep;26(3):222–227. doi: 10.1016/s0003-4975(10)63674-0. [DOI] [PubMed] [Google Scholar]
  4. Burman S. O. The prophylactic use of digitalis before thoracotomy. Ann Thorac Surg. 1972 Oct;14(4):359–368. doi: 10.1016/s0003-4975(10)65242-3. [DOI] [PubMed] [Google Scholar]
  5. Csicsko J. F., Schatzlein M. H., King R. D. Immediate postoperative digitalization in the prophylaxis of supraventricular arrhythmias following coronary artery bypass. J Thorac Cardiovasc Surg. 1981 Mar;81(3):419–422. [PubMed] [Google Scholar]
  6. Gettes L. S., Surawicz B. Long-term prevention of paroxysmal arrhythmias with propranolol therapy. Am J Med Sci. 1967 Sep;254(3):257–265. [PubMed] [Google Scholar]
  7. Gianelly R., Griffin J. R., Harrison D. C. Propranolol in the treatment and prevention of cardiac arrhythmias. Ann Intern Med. 1967 Apr;66(4):667–676. doi: 10.7326/0003-4819-66-4-667. [DOI] [PubMed] [Google Scholar]
  8. Goldstein R. E., Corash L. C., Tallman J. F., Jr, Lake C. R., Hyde J., Smith C. C., Capurro N. L., Anderson J. C. Shortened platelet survival time and enhanced heart rate responses after abrupt withdrawal of propranolol from normal subjects. Am J Cardiol. 1981 May;47(5):1115–1122. doi: 10.1016/0002-9149(81)90222-8. [DOI] [PubMed] [Google Scholar]
  9. Johnson L. W., Dickstein R. A., Fruehan C. T., Kane P., Potts J. L., Smulyan H., Webb W. R., Eich R. H. Prophylactic digitalization for coronary artery bypass surgery. Circulation. 1976 May;53(5):819–822. doi: 10.1161/01.cir.53.5.819. [DOI] [PubMed] [Google Scholar]
  10. Jones E. L., Kaplan J. A., Dorney E. R., King S. B., 3rd, Douglas J. S., Jr, Hatcher C. R., Jr Propranolol therapy in patients undergoing myocardial revascularization. Am J Cardiol. 1976 Nov 23;38(6):696–700. doi: 10.1016/0002-9149(76)90345-3. [DOI] [PubMed] [Google Scholar]
  11. Kirsh M. M., Behrendt D. M., Jackson A. P., Dhadphale P., Alseri S., Brymer J., Orringer M. B., Sloan H. Myocardial revascularization in patients receiving long-term propranolol therapy. Ann Thorac Surg. 1978 Feb;25(2):117–121. doi: 10.1016/s0003-4975(10)63503-5. [DOI] [PubMed] [Google Scholar]
  12. Krasula R. W., Hastreiter A. R., Levitsky S., Yanagi R., Soyka L. F. Serum, atrial, and urinary digoxin levels during cardiopulmonary bypass in children. Circulation. 1974 Jun;49(6):1047–1052. doi: 10.1161/01.cir.49.6.1047. [DOI] [PubMed] [Google Scholar]
  13. Mason D. T., Zelis R., Lee G., Hughes J. L., Spann J. F., Jr, Amsterdam E. A. Current concepts and treatment of digitalis toxicity. Am J Cardiol. 1971 May;27(5):546–559. doi: 10.1016/0002-9149(71)90418-8. [DOI] [PubMed] [Google Scholar]
  14. Miller R. R., Olson H. G., Amsterdam E. A., Mason D. T. Propranolol-withdrawal rebound phenomenon. Exacerbation of coronary events after abrupt cessation of antianginal therapy. N Engl J Med. 1975 Aug 28;293(9):416–418. doi: 10.1056/NEJM197508282930902. [DOI] [PubMed] [Google Scholar]
  15. Mohr R., Smolinsky A., Goor D. A. Prevention of supraventricular tachyarrhythmia with low-dose propranolol after coronary bypass. J Thorac Cardiovasc Surg. 1981 Jun;81(6):840–845. [PubMed] [Google Scholar]
  16. Oka Y., Frishman W., Becker R. M., Kadish A., Strom J., Matsumoto M., Orkin L., Frater R. Clinical pharmacology of the new beta-adrenergic blocking drugs. Part 10. Beta-adrenoceptor blockade and coronary artery surgery. Am Heart J. 1980 Feb;99(2):255–269. doi: 10.1016/0002-8703(80)90774-7. [DOI] [PubMed] [Google Scholar]
  17. Roffman J. A., Fieldman A. Digoxin and propranolol in the prophylaxis of supraventricular tachydysrhythmias after coronary artery bypass surgery. Ann Thorac Surg. 1981 Jun;31(6):496–501. doi: 10.1016/s0003-4975(10)61337-9. [DOI] [PubMed] [Google Scholar]
  18. Shields T. W., Ujiki G. T. Digitalization for prevention of arrhythmias following pulmonary surgery. Surg Gynecol Obstet. 1968 Apr;126(4):743–746. [PubMed] [Google Scholar]
  19. Stephenson L. W., MacVaugh H., 3rd, Tomasello D. N., Josephson M. E. Propranolol for prevention of postoperative cardiac arrhythmias: a randomized study. Ann Thorac Surg. 1980 Feb;29(2):113–116. doi: 10.1016/s0003-4975(10)61647-5. [DOI] [PubMed] [Google Scholar]
  20. Tyras D. H., Stothert J. C., Jr, Kaiser G. C., Barner H. B., Codd J. E., Willman V. L. Supraventricular tachyarrhythmias after myocardial revascularization: a randomized trial of prophylactic digitalization. J Thorac Cardiovasc Surg. 1979 Feb;77(2):310–314. [PubMed] [Google Scholar]
  21. Viljoen J. F., Estafanous F. G., Kellner G. A. Propranolol and cardiac surgery. J Thorac Cardiovasc Surg. 1972 Nov;64(5):826–830. [PubMed] [Google Scholar]
  22. Wechsler A. S. Assessment of prospectively randomized patients receiving propranolol therapy before coronary bypass operation. Ann Thorac Surg. 1980 Aug;30(2):128–136. doi: 10.1016/s0003-4975(10)61228-3. [DOI] [PubMed] [Google Scholar]
  23. Wisoff B. G., Hartstein M. L., Aintablian A., Hamby R. I. Risk of coronary surgery. Two hundred consecutive patients with no hospital deaths. J Thorac Cardiovasc Surg. 1975 May;69(5):669–673. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES