Abstract
Introduction: Atrial fibrillation (AF) is common after cardiac surgery and related to postoperative complications and length of stay (LOS). We studied the effect of postoperative use of amiodarone (amio) on the incidence of AF, neurologic and pulmonary events, as well as LOS in 694 patients (pts) with no history of AF, who underwent cardiac surgery at one institution. Methods: During calendar year 2007, 694 consecutive pts were evaluated. From July through December, 311 pts (amio group) received 150 mg intravenous amiodarone bolus at the end of surgery, followed by 400 mg orally twice a day for 7 days, and 200 mg orally daily for 7 more days. If AF developed before oral amiodarone could be started, pts received additional 150 mg drug boluses. Outcomes were compared against a control group of 307 pts who underwent cardiac surgery at the same institution during the first 6 months of 2007. AF was defined as any episode of atrial fibrillation requiring treatment. Results: The mean patient age was 67±12 yrs, 33% were female and 90% received postoperative beta-blocker. AF occurred in 29% of the cohort, and was significantly reduced from 34% in the control group to 24% in the amio group (p<0.004). The reduction in AF was consistent for patients undergoing CABG and/or valve surgery. There was no increase in ventilator time (median 13 hrs) or pulmonary complications in the amio group. Neurologic events were low (4%) and equal in both groups as was the need for postoperative pacemaker therapy (4%). The median LOS was 10 days and not affected by amio treatment. Conclusions: Short-term use of amiodarone postoperatively decreases the incidence of AF in patients treated with beta-blocker after cardiac surgery. No increase in adverse events was identified nor influence on LOS. Thus, amiodarone treatment postoperatively appears safe and effective.
Published Version
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