Abstract 18414: Could Tolvaptan Prevent the New Onset of Atrial Fibrillation After Cardiac Surgery?
Introduction: Atrial fibrillation (Af) occurs frequently after cardiac surgery and not only prolongs hospitalization but also influences the prognosis. Tolvaptan (TV) has a strong diuretic effect, which is beneficial for body fluid management in patients with acute heart failure. We hypothesized that concomitant administration of TV with conventional diuretic treatment is beneficial for perioperative body fluid management in patients who have undergone cardiac surgery, which may reduce postoperative Af. In this study, we prospectively randomized the patients into the TV group, in which TV was administered, and the control group, in which the patients received conventional diuretics only. Our primary endpoint was occurrence of Af. Logistic regression analysis was performed to investigate risk factors for Af.
Methods: 165 patients who underwent cardiac surgery between July 2013 and February 2016 were included in the study and divided into 2 groups, which were the TV group (TV, TV + furosemide, 92 patients) and conventional diuretic treatment group (Control [C], furosemide, 73 patients). We compared urine output for 3 days after surgery, the time required to restore the preoperative body weight, and the occurrence of postoperative Af between the 2 groups. In the TV group, patients received TV 7.5mg/day orally starting on postoperative day (POD) 1 and continued to take TV up to POD 5 or until the body weight returned to the preoperative value.
Results: The mean ages of the TV and C groups were 70.0 ± 12.3 and 69.3 ± 13.5 years old, respectively. The mean daily urine output from POD1 to POD 3 of the TV group (2672 ± 769 mL/day) was higher than that of the C group (2240 ± 529 mL/day) (p = 0.001). The time required to restore preoperative body weight was shorter in the TV group (3.8 ± 1.4 days) than in the C group (4.8 ± 2.0 days) (p=0.003). Af occurred 21 patients (22.8 %) in the TV group versus 27 patients (37.0 %) in the C group (p < 0.05). Multivariate analysis revealed that significant risk factors for Af was a non-use of TV.
Conclusion: Administration of TV with conventional diuretics in the early postoperative period after cardiac surgery could be beneficial not only in maintaining urine output, but also in reducing the occurrence of postoperative Af.
Author Disclosures: Y. Kishimoto: None. Y. Nakamura: None. Y. Fujiwara: None. S. Harada: None. T. Ohnohara: None. S. Kishimoto: None. T. Kurashiki: None. M. Nishimura: None.
- © 2016 by American Heart Association, Inc.