Intravenous and Oral Amiodarone for the Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery
Background. Atrial fibrillation is still a frequent complication that increases morbidity after coronary artery bypass grafting. This prospective randomized study is designed to define efficacy of postoperative amiodarone prophylaxis in preventing atrial fibrillation after off-pump coronary artery bypass grafting.
Methods. One hundred forty-four patients who underwent elective off-pump coronary artery bypass grafting were enrolled for the study. Seventy-six patients (amiodarone group) received 5 mg/kg loading amiodarone infusion in the first postoperative hour, followed by 10 mg/kg for the first 24 hours. After 24 hours, patients received 600 mg/day amiodarone orally for 7 days and 200 mg/day until the end of the postoperative first month. Sixty-eight patients received placebo (control group).
Results. Preoperative characteristics and operative variables of the patients were similar in both groups. Incidence of new-onset atrial fibrillation and maximal ventricular rate response were recorded. The incidence of new-onset atrial fibrillation (11.8% versus 26.5%) (P = .025) and maximal ventricular rate response (109 ± 13.8 beats/min versus 124.5 ± 13.9 beats/min) (P = .011) were significantly lower in the amiodarone group. Duration of atrial fibrillation was 17.5 ± 8.1 hours for the amiodarone group compared with 32.7 ± 12 hours for the control group (P = .002).
Conclusion. Postoperative intravenous amiodarone prophylaxis followed by oral amiodarone significantly reduces the incidence of atrial fibrillation after off-pump coronary artery bypass grafting and the ventricular rate during atrial fibrillation.
Abel RM, van Gelder HM, Pores IH, Liguori J, Gielchinsky I, Parsonnet V. 1983. Continued propranolol administration following coronary bypass surgery: antiarrhythmic effects. Arch Surg118:727-31.nAranki SF, Shaw DP, Adams DH, et al. 1996. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation94:390-7.nAscione R, Caputo M, Calori G, Lloyd CT, Underwood MJ, Angelini GD. 2000. Predictors of atrial fibrillation after conventional and beating heart coronary surgery: a prospective, randomized study. Circulation102:1530-5.nButler J, Harriss DR, Sinclair M, Westaby S. 1993. Amiodarone prophylaxis for tachycardia after coronary artery bypass surgery: a randomized double-blind placebo controlled trial. Br Heart J70:56-60.nCohn WE, Sirois CA, Johnson RG. 1999. Atrial fibrillation after minimally invasive coronary artery bypass grafting: a retrospective, matched study. J Thorac Cardiovasc Surg117:298-301.nCreswell LL, Schuessler RB, Rosenbloom M, Cox JL. 1993. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg56:539-49.nCsicsko JF, Schatzlein MH, King RD. 1981. Immediate postoperative digitization in the prophylaxis of supraventricular arrhythmias following coronary artery bypass. J Thorac Cardiovasc Surg81:419-22.nDaoud EG, Strickberger SA, Man KC, et al. 1997. Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med337:1785-91.nDavison R, Hartz R, Kaplan K, Parker M, Feiereisel P, Michaelis L. 1985. Prophylaxis of supraventricular tachyarrhythmia after coronary bypass surgery with oral verapamil: a randomized, double-blind trial. Ann Thorac Surg39:336-9.nDoggrell SA. 2001. Amiodarone—waxed and waned and waxed again. Expert Opin Pharmacother2:1877-90.nDorge H, Schoendube FA, Schoberer M, Stellbrink C, Voss M, Messmer BJ. 2000. Intraoperative amiodarone as prophylaxis against atrial fibrillation after coronary operations. Ann Thorac Surg69: 1358-62.nDucceschi V, D'Andrea A, Liccardo B, et al. 1999. Perioperative clinical predictors of atrial fibrillation occurrence following coronary artery bypass surgery. Eur J Cardiothorac Surg16:435-9.nFerguson TB Jr, Smith LS, Smith PK, Damiano RJ, Cox JL. 1987. Electrical activity in the heart during hyperkalemic hypothermic cardioplegic arrest: site of origin and relationship to specialized conduction tissue. Ann Thorac Surg43:373-9.nGallagher ME, Morewood GH, Garcia JP, Furukawa S. 2001. Amiodarone for atrial fibrillation during off pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth15:611-13.nGosselink AT, Crijns HJ, Van Gelder IC, Hillige H, Wiesfeld AC, Lie KI. 1992. Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. JAMA267:3289-93.nHammon JW Jr, Wood AJ, Prager RL, Wood M, Muirhead J, Bender HW Jr. 1984. Perioperative beta blockade with propranolol: reduction in myocardial oxygen demands and incidence of atrial and ventricular arrhythmias. Ann Thorac Surg38:363-7.nHohnloser SH, Meinertz T, Dammbacher T, et al. 1991. Electrocardiographic and antiarrhythmic effects of intravenous amiodarone: results of a prospective, placebo-controlled study. Am Heart J121:89-95.nKerstein J, Soodan A, Qamar M, et al. 2004. Giving IV amiodarone perioperatively for the prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery: the GAP study. Chest126:716-24.nKowey PR, Marinchak RA, Rials SJ, Filart RA. 1997. Intravenous amiodarone. J Am Coll Cardiol29:1190-8.nLauer M, Eagle K. 1995. Arrhythmias following cardiac surgery. In: Podrid P, Kowey P, eds. Cardiac Arrhythmia. Mechanism, Diagnosis and Management. Baltimore: MD; Williams and Wilkins: 1206.nLee SH, Chang CM, Lu MJ, et al. 2000. Intravenous amiodarone for prevention of atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg70:157-61.nLeitch JW, Thomson D, Baird DK, Harris PJ. 1990. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg100:338-42.nMartinussen HJ, Lolk A, Szczepanski C, Alstrup P. 1988. Supraventricular tachyarrhythmias after coronary bypass surgery: a double blind randomized trial of prophylactic low dose propranalol. J Thorac Cardiovasc Surg36:206-7.nMathew JP, Parks R, Savino JS, et al. 1996. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. Multi Center Study of Perioperative Ischemia Research Group. JAMA276:300-6.nPuskas JD, Wright CE, Ronson RS, et al. 1998. Off-pump multivessel coronary bypass via sternotomy is safe and effective. Ann Thorac Surg66:1068-72.nRedle JD, Khurana S, Marzan R, et al. 1999. Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass surgery. Am Heart J138:144-50.nRousou JA, Meeran MK, Engelman RM, Breyer RH, Lemeshow S. 1985. Does the type of venous drainage or cardioplegia affect postoperative conduction and atrial arrhythmias? Circulation72:II259-63.nSalamon T, Michler RE, Knott KM, Brown DA. 2003. Off-pump coronary artery bypass grafting does not decrease the incidence of atrial fibrillation. Ann Thorac Surg75:505-7.nShafei H, Nashef SA, Turner MA, Bain WH. 1998. Does low dose propranolol reduce the incidence of supraventricular tachyarrhythmias following myocardial revascularization? A clinical study. J Thorac Cardiovasc Surg36:202-5.nTaylor GJ, Malik SA, Colliver JA, et al. 1987. Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting. Am J Cardiol.60:905-7.nZarembski DG, Nolan PE, Slack MK, Caruso AC. 1995. Treatment of resistant atrial fibrillation: a meta-analysis comparing amiodarone and flecainide. Arch Intern Med155:1885-91.n
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