Impact of Prophylactic Amiodarone on Length of Hospital Stay, Stroke, and Atrial Fibrillation After Cardiothoracic Surgery

Abstract

To evaluate the effect of prophylactic amiodarone on length of stay (LOS), postoperative stroke, and postoperative atrial fibrillation (POAF). Retrospective cohort study. Hartford Hospital, Hartford, Connecticut. Two thousand forty-six patients who underwent cardiothoracic surgery from February 1998-October 2003 (186 received amiodarone, 1860 were controls). Patients receiving any of the prophylactic amiodarone regimens used in the Atrial Fibrillation Suppression Trials (AFIST) I and II were matched (1:10 matching) for age, valvular surgery, history of atrial fibrillation, sex, beta-blocker intolerance, and preoperative digoxin therapy with patients not receiving amiodarone prophylaxis. The AFIST regimens consisted of oral amiodarone 6 g over 6 days and 7 g over 10 days, beginning on preoperative days 1 and 5, respectively, or a hybrid intravenous and oral loading regimen delivering amiodarone 7 g over 5 days. Mean+/-SD age of the patients was 68.9+/-9.8 years, 75% were men, and 21% had undergone valvular surgery. Patients receiving prophylactic amiodarone had a shorter LOS (8.6+/-6.0 days) than controls (11.6+/-14.0 days, p=0.003) and a reduced frequency of POAF (23.1% vs 29.9%, p=0.05). Frequency of stroke was not significantly affected (2.2% vs 2.7% in the amiodarone vs control groups, p=0.61). Use of the prophylactic amiodarone regimens from the AFIST trials reduced LOS by 3.0 days and frequency of POAF by 22.7%.