開心術後の発作性心房細動に対する経皮吸収型β1遮断薬の有用性

Efficacy of Transdermal Patch of Bisoprolol for Paroxysmal Atrial Fibrillation after Open Heart Surgery

開心術後の発作性心房細動（paroximal atrial fibrillation：PAF）は，血行動態の破綻や塞栓症を誘発し，循環管理が複雑になって抗凝固療法を必要とするなど無視できない合併症である．ガイドラインではβ遮断薬の継続使用が推奨されており1），本邦ではlandiolol hydrochlorideの点滴治療が一般的である2）．しかし，洞調律と心房細動を繰り返す場合には厳格な点滴管理

2014 American Association for Thoracic Surgery （AATS） guidelines recommend beta blocker for prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. In recent years, transdermal patch of bisoprolol （TDPB） has become available in Japan. We examined the efficacy of TDPB for paroxysmal atrial fibrillation （PAF） after open heart surgery. Among 289 patients who had undergone open heart surgery in our hospital from December 2013 to April 2016, 48（16.6％）patients, for whom TDPB was used for PAF, were analyzed retrospectively. The summary of our PAF protocol：HR ＞80；a sheet of TDPB （4 mg） is pasted, HR≦60；TDPB is removed, HR ＞140 persisted；another sheet of TDPB is added. Eighteen of the 48 （37.5％） patients recovered sinus rhythm within 24 hours. Six patients （12.5％）, because of persistent tachycardia, shifted to continuous infusion of landiolol. Ten underwent electrical defibrillation during hospitalization. In 3 patients, TDPB was removed due to advanced bradycardia. TDPB could be used safely and feasibly for PAF after open heart surgery.