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Date of Graduation

8-2003

Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Jon Gietzen, PA-C

Abstract

Objectives: The purpose of this retrospective study was to assess the efficacy and safety of postoperatively administered oral sotalol (Betapace) in the treatment of post-coronary artery bypass grafting (CABG) surgery atrial fibrillation/flutter (AF/F).

Background: Atrial fibrillation is the most common arrhythmia following CABG surgery. There is no current standard of treatment for this condition. Furthermore, AF's secondary complications can cause death and its occurrence after CABG prolongs length of hospital stay and increases costs for both the patient and the hospital.

Methods: This is a retrospective study using chart reviews to collect data at a single institution (Scripps Clinic Green Hospital). We studied 102 patients who underwent first time, isolated CABG surgery with cardiopulmonary bypass (CPB) and had no previous history of atrial fibrillation. To preserve a pure population we excluded patients with previous history of recur ant paroxysmal atrial fibrillation/atrial flutter or preoperative atrial fibrillation/atrial flutter, patients who had CABG surgery performed with off-pump technique, patients who underwent additional surgery at the same time as the CABG. Using this population, we evaluated the efficacy of sotalol in the treatment of post-CABG AFIF.

Results: We collected data from 102 charts. AF/F occurred in 40/102 (39%) patients. The time it took for the medication to convert a patient from AFIF to normal sinus rhythm (NSR) was significantly faster in the sotalol only treatment group compared to the non-sotalol group (p=0.0179) [25 hrs vs. 78hrs]. The sotalol only group also had a significantly shorter length of stay for both ICU (p

Conclusions: Using sotalol as the first line treatment in post-CABG AF/F provided faster conversion to sinus rhythm and decreased ICU/hospital length of stay (LOS), as well as a low incidence of adverse effects at this institution. Postoperative CABG AFIF treatment with sotalol appears promising and deserves prospective testing on a larger scale.

Comments

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