Managing postoperative atrial fibrillation after open-heart surgery using transdermal β1 blockers

Abstract Background Postoperative atrial fibrillation (POAF) after open-heart surgery is a non-negligible complication. We aimed to describe the efficacy of a transdermal patch of bisoprolol for managing POAF and flutter in thoracic surgical procedures. Methods We analyzed 384 patients who underwent open-heart surgery at our hospital and received oral bisoprolol to prevent POAF. Among them, 65 patients (16.9%) also received a 4-mg transdermal patch of bisoprolol to control heart rate due to POAF. We applied the bisoprolol transdermal patch when the heart rate was > 80 bpm and removed it at ≤ 60 bpm; an additional patch was applied when the heart rate was > 140 bpm. Heparin calcium injections were administered twice daily for anticoagulation between 2 and 6 days postoperatively. Results The average number of prescriptions for transdermal patches of bisoprolol during hospitalization was 1.8 ± 1.1 (1–5). The median first prescription date was on postoperative day 2 (range: days 0–37). Sinus rhythm recovered within 24 h in 18 patients (27.7%). Eight patients (12.3%) were switched to continuous landiolol infusion due to persistent tachycardia. In three patients, the transdermal patch was removed due to severe bradycardia. Fifteen patients experienced persistent atrial fibrillation and were treated with electrical cardioversion during hospitalization. We did not observe any serious complications that could be directly attributed to bisoprolol transdermal patch use. Conclusions Single-use bisoprolol transdermal patch may help control heart rate during the initial treatment of POAF after open-heart surgery.