Circulation, Vol 70, 479-484, Copyright © 1984 by American Heart Association
HD White, EM Antman, MA Glynn, JJ Collins, LH Cohn, RJ Shemin and PL Friedman
Forty-one patients undergoing coronary artery bypass grafting were randomly
assigned to receive prophylactic timolol or placebo, given in a
double-blind fashion. beta-Adrenoceptor-blocking therapy was stopped at
least one half-life before surgery. Three to 7 hr after surgery (304 +/- 56
min), 0.5 mg of timolol or placebo was given intravenously twice daily in a
double-blind manner. When oral medications were resumed postoperatively, 10
mg of timolol twice daily or placebo was continued orally. Continuous
electrocardiograms were recorded for 24 hr before and for 7 days after
surgery with a standard cassette recorder. No patient received digoxin.
Both groups were comparable for frequency of preoperative supraventricular
arrhythmias, left ventricular ejection fraction, duration of
cardiopulmonary bypass, aortic cross-clamp time, number of bypass grafts,
and total duration of monitoring. Analysis of arrhythmias was done by hand
counts, and supraventricular arrhythmias were divided into supraventricular
tachycardia and atrial fibrillation and/or flutter. Timolol decreased the
frequency of supraventricular tachycardia (581 episodes placebo vs 84
timolol; p less than .05) and of atrial fibrillation and/or flutter (291
episodes placebo vs five timolol; p less than .05). Timolol decreased the
number of patients with severe (heart rate greater than 200 beats/min,
duration greater than 50 beats) episodes of supraventricular tachycardia
(four placebo vs 0 timolol; p less than .05) and also decreased the number
of episodes of severe (heart rate greater than 200 beats/min, duration
greater than 5 min) atrial fibrillation and/or flutter (16 placebo vs one
timolol; p less than .005). There were differences in the durations of
supraventricular arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Efficacy and safety of timolol for prevention of supraventricular tachyarrhythmias after coronary artery bypass surgery
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