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August 7, 2002

Preoperative β-Blockade and Risk of Postoperative Atrial Fibrillation—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(5):573-574. doi:10.1001/jama.288.5.571

In Reply: The direct effect of preoperative β-blocker therapy on postoperative AF is perhaps more complex that it first appears, for several reasons. First, while randomized controlled trials have documented the beneficial effect of β-blockade for prevention of AF,1,2 in clinical practice patients may receive β-blockers for reasons other than either preoperative or postoperative arrhythmia prevention. They may also have an unrelated contraindication to the drug. Second, several of these trials have shown that patients who receive β-blockers preoperatively, but who do not have β-blockade restarted postoperatively, have an increased incidence of postoperative arrhythmias.2 Third, it can sometimes be difficult to discriminate whether some antiarrhythmic drugs are administered for prophylaxis, therapy, or both.

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