Postoperative Atrial Fibrillation Prevention in Patients Undergoing Coronary Artery Bypass Grafting by Using Perioperative HCN Channel Blockers and Selective Beta Blockers

Background: Postoperative atrial fibrillation (AF) is commonly occurring following coronary artery bypass graft (CABG) surgery. Controversies are present regarding the superior medications that prevent AF.
Objective: To evaluate the efficacy of the perioperative use of bisoprolol and ivabradine versus bisoprolol alone as a prophylactic treatment in the prevention of postoperative AF in patients underwent elective CABG surgery.
Patients and Methods: This is a prospective interventional study included 50 adult patients who underwent elective CABG surgery. Patients were assessed for eligibility from Department of Cardiothoracic Surgery in Benha University Hospitals. Patients were randomly divided into two equal groups; Group I received both ivabradine (Procoralan®) and Bisoprolol (Concor®) and Group II received bisoprolol (Concor®) only. Both groups received their treatments 48 hours before surgery and continued one week postoperatively.  Ethical approval and informed written consents were obtained.
Results: Postoperative prevention of postoperative atrial fibrillation in the combination therapy (Ivabradine plus bisoprolol) (group I) was more effective than bisoprolol given alone (group II). There was a statistically significant increase in the overall postoperative atrial fibrillation among patients in group II compared with group I (36% vs. 4%, respectively, P value=0.01).
Conclusion: Ivabradine is a safe and effective drug to be administered along with a beta blocker (Bisoprolol) perioperatively in patients undergoing CABG surgery in terms of reducing heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), intensive care unit (ICU) stay, and better postoperative echocardiographic data and significantly reducing the incidence of the overall postoperative atrial fibrillation.