β-Blockade Therapy for Supraventricular Tachyarrhythmias After Coronary Surgery: A Propranolol Withdrawal Syndrome?

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Abstract
A high incidence of cardiac arrhythmias and hypertension was noted after coronary artery bypass surgery in patients previously treated with oral propranolol. Forty-two patients undergoing coronary bypass surgery had propranolol withdrawn 10 h before surgery and were randomized into a group treated with propranolol immediately postoperatively and a nontreatment group. Patients treated with prophylactic propranolol had a significantly lower incidence of postoperative supraventricular arrhythmias compared to patients who received no prophylaxis. All the arrhythmias responded rapidly to 1 mg of i.v. propranolol therapy whether it was used as a primary treatment or as a supplement to prophylactic propranolol. There is a high incidence of supraventricular arrhythmias and sinus tachycardia after coronary artery bypass which might reflect an abrupt propranolol withdrawal. Perioperative, prophylactic or supplementary propranolol therapy will successfully prevent or treat most of these arrhythmias.