Prevention of postoperative arrhythmias after pulmonary resection: celiprolol versus magnesium

Introduction

Incidence of arrhythmia after lobectomies is between 10% and 20% and approaches 40% after pneumonectomy. Postoperative arrhythmia is associated with higher morbidity and mortality [1]. The objective of this study was to compare the effect of oral β-blocker (celiprolol) and intravenous magnesium (Mg) on the frequency of supraventricular arrhythmia (SVA) after pulmonary resection.

Methods

Twenty-six patients undergoing pneumonectomy or bilobectomy were randomised to receive either celiprolol (group 1, n = 13) or intravenous Mg (group 2, n = 13). Patients were excluded if they had a history of congestive heart failure, second-degree or greater heart block, a history of SVA, or were receiving oral β-blocker, diltiazem, or verapamil. Patients of group 1 received oral celiprolol (100 mg every 8 hours) starting before operation and continued for 10 days postoperatively. Group 2 received intravenously 2 g Mg at the time of the thoracotomy, at 6 hours then every day for 3 days. All patients were followed clinically with at least four daily ECGs for up to 10 days. Statistical analyses were performed using the statistical package SPSS version 11.0. P < 0.05 was considered significant.

Results

The mean age of the 26 patients was 53 ± 14 years. SVA developed in 42.3% of the patients and atrial fibrillation (AF) in 19.2%. The mean cardiac frequency was 82 ± 10 pulses/minute in group 1 versus 92 ± 10 pulses/minute in group 2. The incidence of SVA was significantly higher in group 2 (30.4% vs. 11.4%, P = 0.047). However, the incidence of AF was similar in the two groups (group 1: 3.8% vs. group 2: 15.2%, P = 0.135). The peak for the occurrence of SVA was on postoperative day 2. Right pneumonectomy and intrapericardial resection were not associated with increased development of postoperative SVA. No serious adverse effects caused by celiprolol or magnesium were seen.

Conclusion

Terzi and colleagues [2] demonstrated a significant reduction in the incidence of AF using Mg. In our study Mg has no role in the prophylaxis of SVA in lung surgery. Perioperative celiprolol can reduce the frequency of SVA without serious side effects. In fact, increased sympathetic activity is one of the predominant factors in the cause of this complication.