מתוך medicontext.co.il
By Martha Kerr
ANAHEIM, CA (Reuters Health) – Beginning anti-arrhythmic treatment with propafenone immediately after coronary artery bypass graft (CABG) surgery cuts the risk of postoperative atrial fibrillation–but lowering the risk cuts neither risk of death nor length of stay in the hospital. Results of COPPA II were reported here Monday at the American Heart Association's 2001 Scientific Sessions.
The lead investigator of the Clinical Outcomes from the Prevention of Post-operative Arrhythmia (COPPA) trial, Dr. Peter R. Kowey of Lankenau Hospital and Institute for Medical Research in Wynnewood, Pennsylvania, noted that the risk of atrial fibrillation (AF) after CABG is about 40%.
In COPPA I, Dr. Kowey and colleagues showed that the postoperative risk could be cut to about 20% with the use of beta-blockers after surgery. Now, in COPPA II, the investigators show that beta-blockers plus moderate-dose propafenone further cuts the risk to 12%, but with no benefit in survival or length of stay.
In COPPA II, investigators randomized 293 patients undergoing bypass surgery to receive placebo or propafenone 675 mg/day or 450 mg/day, administered within 24 hours of surgery and continued for up to 15 days. Nearly all patients in all three groups also received digoxin and beta-blockers.
The percentage of patients who developed postoperative AF was 22% in the placebo and lower-dose groups and 12% in the high-dose propafenone group. This is the lowest postoperative AF rate ever observed, Dr. Kowey noted. Time to AF was 3 to 4 days in the placebo and low-dose groups and about 5 days for patients in the high-dose group. The safety of propafenone prophylaxis was confirmed in this trial.
Length of stay was the same in all three groups, at about 7 days. Mortality rates were similar in all three groups as well.
The earlier the anti-arrhythmic therapy begins, the better it works, Dr. Kowey said. And although it doesn't improve outcome, "I still think it is worthwhile [to give anti-arrhythmics] for patient comfort," he added.
"I would like to treat patients for atrial fib," Dr. Kowey told Reuters Health, "even though [the drugs] don't seem to make a whole lot of difference in the clinical setting…But my gut tells me that they should help."
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