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Is Sotalol A Better Choice Over Metoprolol for Atrial Fibrillation Prophylaxis Post Coronary Artery Bypass Graft Surgery?

15 August 2009


Background: Atrial Fibrillation (AF) is the most common arrhythmia post Coronary Artery Bypass Graft surgery (CABG). Up to 50% of patients who undergo a CABG procedure will have AF. Metoprolol, a conventional beta-blocker, has been the drug of choice for AF prophylaxis. Sotalol, also a beta-blocker, with class III antiarrythmic effects, could possibly provide a better prophylaxis intervention of AF post CABG surgery.

Methods: The focus of this study was to review clinical trials on the comparison between sotalol and metoprolol. A thorough review of clinical trials within the last twelve years, pertaining to sotalol versus metoprolol and sotalol versus placebo, were carefully selected and analyzed. Double-blinded and randomized clinical trials of metoprolol and sotalol were identified by systematic literature search using Medline, CINAHL, Medscape, and MD consult search engines.

Results: Based on the five clinical trials analyzed, atrial fibrillation incidences were lowest in the sotalol groups (as low as 12.5 %) versus metoprolol groups (19%), and placebo groups (18%). Data gathered also demonstrates sotalol and metoprolol reducing hospital length of stay to at least half a day when compared to placebo.

Conclusion: Metoprolol and Sotalol both reduce the risk of post-operative AF, sotalol having a greater efficacy than metoprolol in reducing the rates of AF post CABG surgery. It is shown however, that sotalol has added adverse effects from its class III antiaryhtmic effects in addition to its beta blocking side effects. There is some evidence, although not significant, that both drugs reduce hospital length of stay (LOS) when compared to placebo, however, there is no marked difference between the two groups, sotalol and metoprolol.


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