MONDAY, June 10, 2002 (HealthDayNews) -- For years, the American Heart Association has urged heart surgeons to use beta blocker drugs to prevent the dangerous irregular heartbeat called atrial fibrillation, which can occur after an operation. A new study that pools the results of 52 separate trials concludes that the advice is right on target.
The current evaluation is necessary because "there have been 23 new studies since the last review 12 years ago," says a report in tomorrow's issue of Circulation: Journal of the American Heart Association. It also adds a new consideration to warrant use of the beta blockers, saying they reduce the time patients spend in the hospital.
"A most important measurable clinical benefit, other than atrial fibrillation prevention itself, is reduction in length of stay by one half of a day," the report says.
The analysis compared the effectiveness of conventional beta blockers, which often are prescribed for high blood pressure, against amiodarone, a drug designed to prevent abnormal heart rhythms, and sotalol, a beta blocker that also has anti-arrhythmic effects. There are no startling differences, says Dr. Eugene Crystal, a visiting fellow from Israel who headed the study in a stay at the arrhythmia service of Hamilton General Hospital in Ontario, Canada. All reduced the incidence of atrial fibrillation by about 40 percent.
"Beta blockers have the same effect as the other drugs, but they are probably the safest and the most widely used," says Crystal.
By Crystal's estimate, at least a third of people who have heart surgery are given beta blockers or other drugs to prevent atrial fibrillation, in which the upper chambers of the heart lose their coordination and flutter uselessly, so that blood is not pumped to the body. The most obvious candidates are people with a history of atrial fibrillation, with decreased heart function another important indicator.
Use of beta blockers "is common for the surgeons I deal with," says Dr. Donald W. Lavan, a spokesman for the American Heart Association. "They will usually start the drug a day before or a few days before surgery, or sometimes give it immediately after surgery," he says.
Lavan, who is a clinical associate professor of medicine at the University of Pennsylvania, notes that the study finds a payoff in convenience and cost for use of beta blockers.
"By decreasing the likelihood of an expected complication, surgeons have one less problem to deal with," he says. "So there is an average reduction of one half day in hospitalization."
"Most folks I know have been using metoprolol as the standard beta blocker," Lavan adds. "It has a good duration of action and few side effects and is available generically. But one can say that you could use any beta blocker."
What To Do
You can learn more about atrial fibrillation from the American Heart Association. Meanwhile, the Texas Heart Institute has a primer on beta blockers.
