開心術後の心房細動に対するlandiololの予防効果

Effect of Landoiolol for Atrial Fibrillation after Open Heart Surgery

開心術後の心房細動は約20～50％に発生するといわれ，比較的多い合併症であるが，術後の脳梗塞の増加，入院期間の延長，長期予後にも影響を与えることが報告されている1～3）．そのため，術後の心房細動の予防は重要であり，その一つの方法としてβ遮断薬が有効であることが知られている4）．当科でも以前より術後の内服開始時には心房細動予防のためβ遮断薬を導入していた．術中からlandiololを使用することで，さらなる心房細動の予防効果があるかを検討する．

Purpose：Postoperative atrial fibrillation （POAF） after open heart surgery is common complication. POAF is reported to prolong hospital stay and increase long-term mortality, therefore prevention of POAF is important. It is widely known that beta blocker decrease POAF, and we had used oral beta blocker after open heart surgery. We examined the effect of intraoperative and postoperative administration of intravenous beta blocker （landiolol） for POAF.

Method：We evaluated 291 consecutive patients who underwent open heart surgery from November 2016 to November 2018. Those who underwent open heart surgery after November 2017 were 145, and 100 of the patients （group A） had intraoperative and postoperative landiolol administration. Those who underwent open heart surgery before November 2017 were 146, and 100 of the patients （group B） did not have landiolol administration. The primary endpoint was incidence of POAF within 7 days after surgery.

Result：There was no significant difference in preoperative character between the groups, other than the ratio of males to females （group A：54 males, 46 females；group B：68 males, 32 females；p＜0.05）. The incidences of POAF were 20％ and 36％ in group A and group B, respectively （p＜0.05）.

Conclusion：Intraoperative and postoperative administration of landiolol is effective for preventing POAF after open heart surgery.