β-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias

Jeffrey R. Balser, Elizabeth A. Martinez, Bradford D. Winters, Philip W. Perdue, Ann Wray Clarke, Wenzheng Huang, Gordon F. Tomaselli, Todd Dorman, Kurt Campbell, Pamela Lipsett, Michael J. Breslow, Brian A. Rosenfeld

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Background: Postoperative supraventricular tachyarrhythmia is a common complication of surgery. Because chemical cardioversion is often ineffective, ventricular rate control remains a principal goal of therapy. The authors hypothesized that patients with supraventricular tachyarrhythmia after major noncardiac surgery who receive intravenous β-adrenergic blockade for ventricular rate control would experience conversion to sinus rhythm at a rate that differs from those receiving intravenous calcium channel blockade. Methods: The rate of conversion to sinus rhythm at 2 and 12 h after treatment was examined in 64 cases of postoperative supraventricular tachyarrhythmia. After adenosine-administration, patients who remained in supraventricular tachyarrhythmia were prospectively randomized to receive either intravenous diltiazem or intravenous esmolol for ventricular rate control (unblinded). Loading and infusion rates were adjusted to achieve equivalent degrees of ventricular rate control. Results: Patients were similar with regard to age and Apache III score. Most patients in both groups had atrial fibrillation (esmolol, 79%; diltiazem, 81%), and none experienced stable conversion with adenosine. Patients randomized to receive esmolol experienced a 59% rate of conversion to sinus rhythm within 2 h of treatment, compared with only 33% for patients randomized to receive diltiazem (intention to treat, P = 0.049; odds ratio, 2.9; 95% confidence interval, 1.046 to 7.8). After 12 h of therapy, the number of patients converting to sinus rhythm increased in both groups (esmolol, 85%; diltiazem, 62%), and the rates of conversion no longer differed significantly. Ventricular rates when supraventricular tachyarrhythmia began and after 2 and 12 h of rate control therapy were similar in the two treatment groups. The in-hospital mortality rate and length of stay in the intensive care unit were not significantly influenced by treatment group. Conclusions: Among adenosine-resistant patients in the intensive care unit with atrial fibrillation after noncardiac surgery, intravenous esmolol produced a more rapid (2-h) conversion to sinus rhythm than did intravenous diltiazem.

Original languageEnglish (US)
Pages (from-to)1052-1059
Number of pages8
JournalAnesthesiology
Volume89
Issue number5
DOIs
StatePublished - Jan 1 1998
Externally publishedYes

Fingerprint

Tachycardia
Adrenergic Agents
Diltiazem
Adenosine
Atrial Fibrillation
Therapeutics
Intensive Care Units
Electric Countershock
Calcium Channels
Hospital Mortality
Length of Stay
Odds Ratio
esmolol
Confidence Intervals
Mortality

Keywords

  • Atrial fibrillation
  • Calcium channel blockade
  • Catecholamines

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Balser, J. R., Martinez, E. A., Winters, B. D., Perdue, P. W., Clarke, A. W., Huang, W., ... Rosenfeld, B. A. (1998). β-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias. Anesthesiology, 89(5), 1052-1059. https://doi.org/10.1097/00000542-199811000-00004

β-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias. / Balser, Jeffrey R.; Martinez, Elizabeth A.; Winters, Bradford D.; Perdue, Philip W.; Clarke, Ann Wray; Huang, Wenzheng; Tomaselli, Gordon F.; Dorman, Todd; Campbell, Kurt; Lipsett, Pamela; Breslow, Michael J.; Rosenfeld, Brian A.

In: Anesthesiology, Vol. 89, No. 5, 01.01.1998, p. 1052-1059.

Research output: Contribution to journalArticle

Balser, JR, Martinez, EA, Winters, BD, Perdue, PW, Clarke, AW, Huang, W, Tomaselli, GF, Dorman, T, Campbell, K, Lipsett, P, Breslow, MJ & Rosenfeld, BA 1998, 'β-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias', Anesthesiology, vol. 89, no. 5, pp. 1052-1059. https://doi.org/10.1097/00000542-199811000-00004
Balser, Jeffrey R. ; Martinez, Elizabeth A. ; Winters, Bradford D. ; Perdue, Philip W. ; Clarke, Ann Wray ; Huang, Wenzheng ; Tomaselli, Gordon F. ; Dorman, Todd ; Campbell, Kurt ; Lipsett, Pamela ; Breslow, Michael J. ; Rosenfeld, Brian A. / β-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias. In: Anesthesiology. 1998 ; Vol. 89, No. 5. pp. 1052-1059.
@article{fb6bb34a5c564d17aa26bc69d2cbb9d0,
title = "β-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias",
abstract = "Background: Postoperative supraventricular tachyarrhythmia is a common complication of surgery. Because chemical cardioversion is often ineffective, ventricular rate control remains a principal goal of therapy. The authors hypothesized that patients with supraventricular tachyarrhythmia after major noncardiac surgery who receive intravenous β-adrenergic blockade for ventricular rate control would experience conversion to sinus rhythm at a rate that differs from those receiving intravenous calcium channel blockade. Methods: The rate of conversion to sinus rhythm at 2 and 12 h after treatment was examined in 64 cases of postoperative supraventricular tachyarrhythmia. After adenosine-administration, patients who remained in supraventricular tachyarrhythmia were prospectively randomized to receive either intravenous diltiazem or intravenous esmolol for ventricular rate control (unblinded). Loading and infusion rates were adjusted to achieve equivalent degrees of ventricular rate control. Results: Patients were similar with regard to age and Apache III score. Most patients in both groups had atrial fibrillation (esmolol, 79{\%}; diltiazem, 81{\%}), and none experienced stable conversion with adenosine. Patients randomized to receive esmolol experienced a 59{\%} rate of conversion to sinus rhythm within 2 h of treatment, compared with only 33{\%} for patients randomized to receive diltiazem (intention to treat, P = 0.049; odds ratio, 2.9; 95{\%} confidence interval, 1.046 to 7.8). After 12 h of therapy, the number of patients converting to sinus rhythm increased in both groups (esmolol, 85{\%}; diltiazem, 62{\%}), and the rates of conversion no longer differed significantly. Ventricular rates when supraventricular tachyarrhythmia began and after 2 and 12 h of rate control therapy were similar in the two treatment groups. The in-hospital mortality rate and length of stay in the intensive care unit were not significantly influenced by treatment group. Conclusions: Among adenosine-resistant patients in the intensive care unit with atrial fibrillation after noncardiac surgery, intravenous esmolol produced a more rapid (2-h) conversion to sinus rhythm than did intravenous diltiazem.",
keywords = "Atrial fibrillation, Calcium channel blockade, Catecholamines",
author = "Balser, {Jeffrey R.} and Martinez, {Elizabeth A.} and Winters, {Bradford D.} and Perdue, {Philip W.} and Clarke, {Ann Wray} and Wenzheng Huang and Tomaselli, {Gordon F.} and Todd Dorman and Kurt Campbell and Pamela Lipsett and Breslow, {Michael J.} and Rosenfeld, {Brian A.}",
year = "1998",
month = "1",
day = "1",
doi = "10.1097/00000542-199811000-00004",
language = "English (US)",
volume = "89",
pages = "1052--1059",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - β-adrenergic blockade accelerates conversion of postoperative supraventricular tachyarrhythmias

AU - Balser, Jeffrey R.

AU - Martinez, Elizabeth A.

AU - Winters, Bradford D.

AU - Perdue, Philip W.

AU - Clarke, Ann Wray

AU - Huang, Wenzheng

AU - Tomaselli, Gordon F.

AU - Dorman, Todd

AU - Campbell, Kurt

AU - Lipsett, Pamela

AU - Breslow, Michael J.

AU - Rosenfeld, Brian A.

PY - 1998/1/1

Y1 - 1998/1/1

N2 - Background: Postoperative supraventricular tachyarrhythmia is a common complication of surgery. Because chemical cardioversion is often ineffective, ventricular rate control remains a principal goal of therapy. The authors hypothesized that patients with supraventricular tachyarrhythmia after major noncardiac surgery who receive intravenous β-adrenergic blockade for ventricular rate control would experience conversion to sinus rhythm at a rate that differs from those receiving intravenous calcium channel blockade. Methods: The rate of conversion to sinus rhythm at 2 and 12 h after treatment was examined in 64 cases of postoperative supraventricular tachyarrhythmia. After adenosine-administration, patients who remained in supraventricular tachyarrhythmia were prospectively randomized to receive either intravenous diltiazem or intravenous esmolol for ventricular rate control (unblinded). Loading and infusion rates were adjusted to achieve equivalent degrees of ventricular rate control. Results: Patients were similar with regard to age and Apache III score. Most patients in both groups had atrial fibrillation (esmolol, 79%; diltiazem, 81%), and none experienced stable conversion with adenosine. Patients randomized to receive esmolol experienced a 59% rate of conversion to sinus rhythm within 2 h of treatment, compared with only 33% for patients randomized to receive diltiazem (intention to treat, P = 0.049; odds ratio, 2.9; 95% confidence interval, 1.046 to 7.8). After 12 h of therapy, the number of patients converting to sinus rhythm increased in both groups (esmolol, 85%; diltiazem, 62%), and the rates of conversion no longer differed significantly. Ventricular rates when supraventricular tachyarrhythmia began and after 2 and 12 h of rate control therapy were similar in the two treatment groups. The in-hospital mortality rate and length of stay in the intensive care unit were not significantly influenced by treatment group. Conclusions: Among adenosine-resistant patients in the intensive care unit with atrial fibrillation after noncardiac surgery, intravenous esmolol produced a more rapid (2-h) conversion to sinus rhythm than did intravenous diltiazem.

AB - Background: Postoperative supraventricular tachyarrhythmia is a common complication of surgery. Because chemical cardioversion is often ineffective, ventricular rate control remains a principal goal of therapy. The authors hypothesized that patients with supraventricular tachyarrhythmia after major noncardiac surgery who receive intravenous β-adrenergic blockade for ventricular rate control would experience conversion to sinus rhythm at a rate that differs from those receiving intravenous calcium channel blockade. Methods: The rate of conversion to sinus rhythm at 2 and 12 h after treatment was examined in 64 cases of postoperative supraventricular tachyarrhythmia. After adenosine-administration, patients who remained in supraventricular tachyarrhythmia were prospectively randomized to receive either intravenous diltiazem or intravenous esmolol for ventricular rate control (unblinded). Loading and infusion rates were adjusted to achieve equivalent degrees of ventricular rate control. Results: Patients were similar with regard to age and Apache III score. Most patients in both groups had atrial fibrillation (esmolol, 79%; diltiazem, 81%), and none experienced stable conversion with adenosine. Patients randomized to receive esmolol experienced a 59% rate of conversion to sinus rhythm within 2 h of treatment, compared with only 33% for patients randomized to receive diltiazem (intention to treat, P = 0.049; odds ratio, 2.9; 95% confidence interval, 1.046 to 7.8). After 12 h of therapy, the number of patients converting to sinus rhythm increased in both groups (esmolol, 85%; diltiazem, 62%), and the rates of conversion no longer differed significantly. Ventricular rates when supraventricular tachyarrhythmia began and after 2 and 12 h of rate control therapy were similar in the two treatment groups. The in-hospital mortality rate and length of stay in the intensive care unit were not significantly influenced by treatment group. Conclusions: Among adenosine-resistant patients in the intensive care unit with atrial fibrillation after noncardiac surgery, intravenous esmolol produced a more rapid (2-h) conversion to sinus rhythm than did intravenous diltiazem.

KW - Atrial fibrillation

KW - Calcium channel blockade

KW - Catecholamines

UR - http://www.scopus.com/inward/record.url?scp=0031740103&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031740103&partnerID=8YFLogxK

U2 - 10.1097/00000542-199811000-00004

DO - 10.1097/00000542-199811000-00004

M3 - Article

VL - 89

SP - 1052

EP - 1059

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 5

ER -