These studies and others laid the foundation for routine -blocker therapy after MI. The use of -blockade in chronic heart failure has also evolved over the years, from a relative contraindication in the past to a mainstay of therapy now, leading to a consistent 30% reduction in mortality, improved well-being, and an improvement in symptoms.205 -Blockers likely protect the heart from the chronic upregulation of adrenergic receptors on the myocardium from epinephrine and norepinephrine, thus reducing remodeling and fibrosis in congestive heart failure. Three -blockers have been shown to be effective in reducing the risk of death in patients with chronic heart and sustained-released metoprolol both of which selectively block 1 -receptors, which blocks 1 -, and 2 -receptors. Many CABG patients with left ventricular (LV) dysfunction have significant heart failure both before and after surgical revascularization, and -blocker therapy can be adminis- tered safely and effectively to the majority. As a rule, LV dysfunction alone is not a contraindication to -blocker therapy after CABG. In summary, -blocker therapy is a mainstay of secondary prevention strategies after surgical revascularization for isch- emic heart disease. -Blocker Therapy Recommendations 1. All CABG patients should be prescribed periopera- tive -blocker therapy to prevent postoperative AF, ideally starting before surgery, unless contraindi- cated (ie, bradycardia, severe reactive airway dis- ease) (Class I; Level of Evidence A). 2. CABG patients with a history of MI should be pre- scribed -blocker therapy unless contraindicated (Class I; Level of Evidence A). 3. CABG patients with LV dysfunction should be pre- scribed -blocker therapy (bisoprolol, sustained- release metoprolol succinate, or carvedilol), unless contraindicated (Class I; Level of Evidence B). 4. 