• Daniela Cardinale, Maria T Sandri, Alessandro Colombo, Michela Salvatici, Ines Tedeschi, Giulia Bacchiani, Marta Beggiato, Carlo A Meroni, Maurizio Civelli, Giuseppina Lamantia, Nicola Colombo, Fabrizio Veglia, Monica Casiraghi, Lorenzo Spaggiari, Marco Venturino, and Carlo M Cipolla.
• *Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Milan, Italy†Laboratory Medicine Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy.‡Cardiology Division, European Institute of Oncology, I.R.C.C.S., Milan, Italy.§Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Milan, Italy.||Department of Thoracic Surgery, European Institute of Oncology, I.R.C.C.S., Milan, Italy.¶Department of Thoracic Surgery, European Institute of Oncology, I.R.C.C.S., University of Milan School of Medicine, Milan, Italy.**Department of Anaesthesiology, European Institute of Oncology, I.R.C.C.S., Milan, Italy.
• Ann. Surg. 2016 Aug 1; 264 (2): 244-51.

ObjectiveWe performed a prospective, randomized clinical study to assess whether prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, reduces the incidence of postoperative atrial fibrillation.BackgroundPostoperative atrial fibrillation is a well recognized complication after lung cancer surgery, with an incidence as high as 30%. Perioperative increase of NT-proBNP has been demonstrated to be a strong independent predictor of postoperative atrial fibrillation in this setting.MethodsNT-proBNP concentration was measured 24 hours before surgery and soon after surgery in 1116 patients. Three hundred twenty (29%) patients showed a high NT-proBNP value and were enrolled: 108 were assigned to the metoprolol group, 102 to the losartan group, and 110 to the control group.ResultsOverall, the incidence of postoperative atrial fibrillation was 20% (n = 64); it was significantly lower in the metoprolol and losartan groups compared with the control group [6%, 12%, and 40%, respectively; relative risk 0.19, 95% confidence intervals (CIs), 0.09-0.37; P < 0.001 in the metoprolol group; and 0.29, 95% CI, 0.16-0.52; P < 0.001 in the losartan group). No significant difference was found when the metoprolol and losartan groups were directly compared (P = 0.21).ConclusionsA prophylactic treatment with metoprolol or losartan, initiated soon after lung cancer surgery in patients with high NT-proBNP levels, significantly reduced the occurrence of postoperative atrial fibrillation.

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