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Preoperative -Blockade and Risk of Postoperative Atrial Fibrillation

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To the Editor: In their study on the effect of preoperative -blocker therapy on coronary artery bypass graft (CABG) surgery outcomes, Dr Ferguson and colleagues¹ did not address its effect on the incidence of postoperative atrial fibrillation (AF). Atrial fibrillation has been reported in 5% to 40% of patients undergoing CABG,² is associated with increased length of hospital stay³ and increased incidence of perioperative stroke,⁴ and generally occurs 2 to 3 days after CABG and seldom earlier.⁵ Although a meta-analysis of randomized controlled trials in 1991 showed that prophylactic -blocker therapy had a protective effect against the development of postoperative AF,⁶ its routine preoperative use is still not universally adopted. Furthermore, it would be interesting to know if the trend toward a decrease in stroke that Ferguson et al observed among patients treated with -blockers was due to a decreased incidence of postoperative AF.

Tsung O. Cheng, MD
Department of . . . [Full Text of this Article]

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