Amiodarone Prophylaxis Research Articles

Navigating the Incidence of Postoperative Arrhythmia and Hospitalization Length: The Role of Amiodarone and Other Antiarrhythmics in Prophylaxis.

Antiarrhythmic drugs play a pivotal role in managing and preventing arrhythmias. Amiodarone, classified as a class III antiarrhythmic, has been used prophylactically to effectively prevent atrial fibrillation postoperatively in cardiac surgeries. However, there is a lack of consensus on the use of amiodarone and other antiarrhythmic drugs as prophylaxis to reduce the occurrence of all types of postoperative arrhythmias in cardiac and non-cardiac surgeries. A comprehensive PubMed query yielded 614 relevant papers, of which 52 clinical trials were analyzed. The data collection included the class of antiarrhythmics, timing or method of drug administration, surgery type, type of arrhythmia and its incidence, and hospitalization length. Statistical analyses focused on prophylactic antiarrhythmics and their respective reductions in postoperative arrhythmias and hospitalization length. Prophylactic amiodarone alone compared to placebo demonstrated a significant reduction in postoperative arrhythmia incidence in cardiac and non-cardiac surgeries (24.01%, p<0.0001), and it was the only treatment group to significantly reduce hospitalization length versus placebo (p = 0.0441). Prophylactic use of class 4 antiarrhythmics versus placebo also demonstrated a significant reduction in postoperative arrhythmia incidence (28.01%, p<0.0001), and while there was no significant statistical reduction compared to amiodarone (4%, p=0.9941), a lack of abundant data provides a case for further research on the prophylactic use of class 4 antiarrhythmics for this indication. Amiodarone prophylaxis remains a prime cornerstone of therapy in reducing postoperative arrhythmia incidence and hospitalization length. Emerging data suggests a need for a broader exploration of alternative antiarrhythmic agents and combination therapies, particularly class 4 antiarrhythmics, in both cardiac and non-cardiac surgeries. This meta-analysis depicts the effectiveness of amiodarone, among other antiarrhythmics, in postoperative arrhythmia incidence and hospitalization length reduction in cardiac and non-cardiac surgeries.

PO-01-020 PERI-OPERATIVE AMIODARONE PROPHYLAXIS IN CARDIOVASCULAR SURGERY: IMPACTS ON POST-OPERATIVE LENGTH OF STAY ACCORDING TO PROCEDURE TYPES

Post-operative Atrial Fibrillation (POAF), occurring in nearly 20-50 percent of cardiovascular surgery (CVS) patients, is associated with prolonged hospitalization and excess costs of care. Peri-operative Amiodarone prophylaxis has been an effective strategy to reduce the incidence of POAF. A retrospective evaluation of the impact of Amiodarone prophylaxis on post-operative length of hospital (LOS) stay, according to CVS procedure types. Hospitalization information was available for 2704 consecutive CVS patients at a single tertiary care centre (2013-2016). CVS included standalone, or combined procedures that involved: valvular heart surgery (VHS), coronary artery bypass graft (CABG), and other miscellaneous procedures (e.g. ascending aorta replacement, endarterectomy). Hierarchical linear regression was used to evaluate the impact of Amiodarone prophylaxis on LOS, adjusted for demographic and clinical characteristics. Among the 2704 patients, there were 866 (32.0%) cases of POAF. LOS, was significantly longer in patients with POAF (+2.78 days, p<0.001). LOS was 1.62 days shorter in patients who received Amiodarone prophylaxis (p=0.007). Within all operative categories, LOS was shorter in patients receiving amiodarone prophylaxis, though statistical significance was only observed in VHS (including VHS + other) and VHS + CABG procedure types. Specifically, Amiodarone prophylaxis was associated with shorter LOS among: patients who had CABG but not VHS (8.26 versus 9.45 days, p= 0.29), patients who had VHS but not CABG (7.62 versus 11.02 days, p<0.001), patients undergoing VHS + CABG (9.36 vs. 12.41 days, p<0.03), and patients undergoing VHS + CABG + other (13.54 versus 15.09 days, p= 0.74). After adjusting for demographic-clinical covariates in a hierarchical multiple regression, Amiodarone prophylaxis remained an independent predictor of shorter LOS (b= -2.3 [-3.7, -0.93], p= 0.001). Other independent predictors included: left atrial diameter of >40 mm (b= 1.7 [0.90, 2.85], p< 0.001), female sex (b= 1.4 [0.56, 2.19], p= 0.001), history of heart failure (b= 2.1 [0.94, 3.30], p< 0.001), and CVS involving VHS + CABG (b= 1.4 [0.15, 2.67], p= 0.03), and VHS + CABG + other (b= 5.1 [2.51, 7.72], p<0.001). Amiodarone prophylaxis is independently associated with significantly shorter LOS following CVS.

Role of Prophylactic Use of Amiodarone to Prevent Post-Operative Dysrhythmias in Patients with Low Ejection Fraction (EF ≤35%)

ABSTRACT:&#x0D; Objective:&#x0D; To determine the role of amiodarone prophylaxis in the prevention of dysrhythmias following coronary artery bypass grafting (CABG) in patients with low ejection fraction (EF).&#x0D; Methods:&#x0D; In this prospective comparative study, we included150 patients who underwent coronary artery bypass grafting (CABG) in Multan Institute of Cardiology within a duration of 07 months from Jan-2019 to Aug-2019 having low ejection fraction (EF ≤35%). In the intervention(amiodarone) group (N=75), 3 mg/Kg of amiodarone was given after removal of X-clamp and before weaning from cardiopulmonary bypass. while in the remaining 75 patients no anti-arrhythmic treatment was given in the peri-operative period. Occurrence of postoperative arrhythmia (AF and bradycardia) during the primary hospital stay after surgery was a primary study endpoint.&#x0D; Results:&#x0D; There was no significant difference between the mean age, gender and body mass index (BMI) of patients in the two groups. Regarding per-operative data, there was no significant difference in number of grafts in amiodarone group 3.9±0.53 and control group 3.04±0.50 (p-value 0.20). Frequency of Atrial fibrillation (AF) after the surgery was significantly differenced in both groups. In the amiodarone group, 13 (17.3%) patients developed POAF and in the control group, POAF occurred in 25 (33.3%) patients (p-value 0.024).&#x0D; Conclusion:&#x0D; Amiodarone prophylaxis significantly lower the incidence of POAF after CABG in patients with low EF. Amiodarone is easy to administer and is a valuable adjuvant for prevention of POAF.

Postoperative atrial fibrillation prophylaxis using a novel amiodarone order set.

BackgroundStudies have demonstrated that chemoprophylaxis following anatomic lung resection can reduce post-operative atrial fibrillation (POAF). However, it is unclear if non-anatomic wedge resection warrants prophylaxis, as previously published rates vary widely. The primary goal of this study was to assess an institutional rate of POAF following anatomic resections with implementation of a novel amiodarone administration regimen compared to wedge resections without prophylaxis.MethodsWe performed a retrospective cohort study of a prospectively maintained database and compared anatomic and wedge lung resection patients from 1/2015 to 4/2018. During the study period, a previously unpublished amiodarone order set consisting of a 300 mg IV bolus followed by 400 mg tablets TID ×3 days was administered to anatomic resection patients ≥65 who met criteria. Wedge resection patients were not intended to receive amiodarone prophylaxis. The primary outcome was POAF incidence. Risk factors for developing POAF were assessed.ResultsA total of 537 patients met inclusion where 56% underwent anatomic resection and 44% wedge resection. Overall, 5.4% of patients experienced POAF. There was a significant reduction in post-anatomic resection POAF as compared to historic rates without prophylaxis (9.3% vs. 20.3%, P<0.001). A single wedge resection patient (0.4%) developed POAF. On multivariable analysis, the only independent POAF risk factor was age ≥65 (OR: 5.41, 95% CI: 1.47–19.85).ConclusionsAdministration of our novel amiodarone order set reduces POAF after anatomic resection; however, POAF following wedge resection is too rare to warrant chemoprophylaxis.

Amiodarone Prophylaxis for Atrial Fibrillation after Coronary Bypass—12 Years Follow-Up

Objectives: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and might be avoided with amiodarone prophylaxis. We investigated the long-term effect of prophylactic amiodarone, in patients undergoing isolated, elective coronary artery bypass grafting (CABG), as well as the long-term prognosis of patients with POAF. Methods: We retrospectively analysed patients included in the randomized, control trial RASCABG allocated to either placebo or amiodarone as POAF prophylaxis. Several outcomes were evaluated using national databases. Patients were stratified and compared by prophylactic groups and rhythm. Cox proportional hazard analysis was used for multivariable analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival and cumulative incidence curves. Results: Prophylactic amiodarone was not related to long-term side effects in comparison to placebo. Patients who developed POAF, were more likely to develop late AF, and had a worse overall survival. There was no difference in the overall survival between prophylactic groups. In the competing risk analysis, amiodarone and POAF was not associated with an increased risk of readmission, but POAF was associated with an increased risk of late AF HR 2.28 [95% CI 1.15; 4.55]. In the multivariable analysis, amiodarone was not associated with late AF, readmission or long-term mortality. Further, no association was found between POAF and late AF, readmission or long-term mortality. Conclusion: Amiodarone is a safe drug for the prevention of POAF in the RASCABG-setting. POAF is related to long-term worse prognosis regarding late AF and mortality.

The effects of amiodarone prophylaxis on cardiac dysrhythmia in acute aluminium phosphide poisoning.

Cardiovascular toxicity is the most common cause of fatality in the first 24 hours of poisoning with aluminium phosphide (AlP). Most often manifesting itself in cardiac dysrhythmias. The aim of this study was to evaluate the benefits of amiodarone prophylaxis against cardiac dysrhythmia in 46 patients with acute AlP poisoning. They were divided in two groups of 23: one receiving amiodarone and the other not (control). The treatment group received amiodarone prophylaxis in the initial intravenous bolus dose of 150 mg, followed by a drip of 1 mg/min for six hours and then of 0.5 mg/min for eighteen hours. Both groups were Holter-monitored for 24 hours since admission. Save for amiodarone, both groups received the same standard treatment. Amiodarone had a significant beneficial effect in reducing the frequency of ST-segment elevation and ventricular fibrillation plus atrial fibrillation (P=0.02 and P=0.01, respectively), but the groups did not differ significantly in mortality (9 vs 11 patients, respectively). The mean time between ICU admission and death (survival time) was significantly longer in the treatment group (22 vs 10 h, respectively; P=0.03). Regardless its obvious limitations, our study suggests that even though amiodarone alone did not reduce mortality, it may provide enough time for antioxidant therapy to tip the balance in favour of survival and we therefore advocate its prophylactic use within the first 24 h of AlP poisoning.

Amiodarone for prevention of atrial fibrillation following esophagectomy

ObjectivesAtrial fibrillation (AF) is a common complication after esophagectomy and is associated with symptoms, hemodynamic instability, prolonged hospital stay, and an increased incidence of mortality. Our objective was to determine the efficacy and safety of intravenous amiodarone for prophylaxis of postesophagectomy AF. MethodsIn this retrospective cohort study, 309 patients who underwent esophagectomy formed the initial cohort. Following propensity score-matching, 110 patients who received prophylactic amiodarone 43.75 mg/hour via continuous intravenous infusion over 96 hours (total dose, 4200 mg) were matched to a control group of patients who did not undergo amiodarone prophylaxis (n = 110). The propensity score was obtained using a multivariate logistic regression model with amiodarone as the variable and the following covariates: age, sex, surgical approach, history of neoadjuvant chemotherapy and/or radiation, chronic obstructive pulmonary disease, heart failure, cardiovascular disease, alcohol use (>7 drinks/week), preadmission β-blockers discontinued during hospitalization, preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, preoperative use of corticosteroids, postoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, postoperative use of corticosteroids, postoperative use of statins, and preoperative Charlson comorbidity index. ResultsThe incidence of AF requiring treatment due to rapid ventricular rate and symptoms was lower in the amiodarone group (17 out of 110 [15.5%] vs 32 out of 110 [29.1%]; odds ratio, 0.45; 95% confidence interval, 0.23-0.86; P = .015). There were no significant differences between the groups in median postoperative length of hospital stay, incidence of pulmonary complications, or mortality. The incidences of hypotension requiring treatment (42.7% vs 21.8%; P = .001), bradycardia (8.2% vs 0.0%; P = .002), and corrected QT interval prolongation (10.9% vs 0.0%; P ≤ .0001) were significantly higher in the amiodarone group. ConclusionsProphylactic intravenous amiodarone is associated with a reduction in the incidence of AF following esophagectomy, but is not associated with shorter postoperative length of hospital stay. Intravenous amiodarone for prophylaxis of postesophagectomy AF is associated with hypotension, bradycardia, and corrected QT interval prolongation.

Invited Commentary

Invited Commentary

Abstract 151: Outcomes Associated With Prophylactic Amiodarone Protocol in Patients Undergoing Cardiac Surgery: A Single Center Experience

Background: The incidence of post-operative atrial fibrillation (POAF) in patients undergoing cardiac surgery is approximately 25-40% and has significant consequences. One large randomized control trial demonstrated that the use of amiodarone prophylaxis decreases the incidence of POAF. To improve the quality of care for cardiac surgery patients and improve outcomes, an amiodarone prophylaxis protocol was implemented at our institution in July 2007. The protocol consisted of administering intravenous amiodarone (150 mg) after surgery, in patients without contraindications, followed by a week of 400 mg of oral amiodarone twice a day and 200 mg daily for one more week. In order to encourage utilization, an order care set was created in the electronic medical record system. We studied the effect of this intervention on practice and clinical outcomes. Methods: We included all patients ≥ 18 years of age without pre-existing atrial fibrillation, undergoing cardiac surgery in 5-year periods before and after the implementation of the amiodarone prophylaxis protocol in July 2007. Data were obtained from the Society of Thoracic Surgery (STS) National Database. The primary outcome was the rate of utilization of amiodarone and secondary outcomes were incidence of STS-defined POAF, stroke, myocardial infarction (MI) and 30-day mortality. Outcomes in the January 2002 to July 2007 time-period were compared with those in the September 2007 to June 2012 time-period. Results: From January 2002 to June 2012, 5473 patients underwent cardiac surgery. The mean age was 66 years, 69% were male and 93% were Caucasian. In the September 2007 to June 2012 time-period, 54% of patients (1303 of 2405) received amiodarone as compared to 11% of patients (330 of 3068) in the January 2002 to July 2007 time-period (p&lt;0.01). The STS-defined incidence of POAF decreased in the September 2007 to June 2012 time-period as compared to the January 2002 to July 2007 time-period [36% (861 of 2405) vs. 38% (1178 of 3068), p= 0.04]. The incidence of stroke [4% (93 of 2405) vs. 6% (103 of 1696), p&lt;0.01] and peri-operative MI [4% (90 of 2405) vs. 12% (378 of 3068), p&lt;0.01] decreased as well but there was no change in 30 day mortality [2% (55 of 2405) vs. 2% (78 of 3068), p = 0.55]. Conclusions: Implementation of an amiodarone prophylaxis protocol order care set was associated with greater utilization of amiodarone. It was also associated with a modest decrease in the incidence of STS-defined POAF, stroke and MI but was not associated with a change in 30-day mortality in patients undergoing cardiac surgery. Further studies are needed to study the cost-effectiveness and risk-benefit analysis of routine amiodarone as prophylaxis.

Diabetics Have the Same Risk and Benefits Regarding Postoperative Amiodarone Prophylaxis for Atrial Fibrillation When Undergoing Surgery for Lung Cancer

Background: To evaluate if the risk for developing atrial fibrillation after lung surgery is higher for diabetics than non-diabetic patients and whether diabetic status prolongs the length of in-hospital stay. Objective: To compare the outcome of amiodarone prophylaxis in diabetics and non-diabetics. Design: Subgroup analysis within a randomized, controlled, double-blinded trial. Results: Development of atrial fibrillation was equally frequent among diabetics (18.2%) and non-diabetics (20.5%) (p = 1.00). Atrial fibrillation occurred in 7.1% of prophylactic diabetics and in 9.3% of prophylactic non-diabetics, while 37.5% non-prophylactic diabetics and 31.3% non-prophylactic non-diabetics experienced atrial fibrillation (p = 0.31). Prophylactic amiodarone was equally effective in diabetics as in non-diabetics with a relative risk of 3.5 (1.8 - 67.0) and the number need to treat of 4.4 (3.3 - 8.3) (p = 0.31). The length of in-hospital stay for diabetics was equal to non-diabetics with an average stay of 7.1 versus 8 days at Aarhus University Hospital (p = 0.61) with similar stays at intermediary and intensive care unit as well as total in-hospital stay of 8.9 versus 10 days (p = 0.60). Conclusions: Diabetics have the same risk of atrial fibrillation and the same benefits from prophylactic amiodarone as non-diabetics after surgery for lung cancer. Furthermore, diabetics have the same length of stay as non-diabetics. No severe adverse effects were found in either group.

Intraoperative loading dose of amiodarone for prophylaxis against atrial fibrillation after valvular heart surgery

Benefit of amiodarone in restoring sinus rhythm (SR) after cardiac surgery was concluded in previous studies that used different protocols for giving amiodarone. The purpose of this study was to assess the use of single parenteral intraoperative loading dose of amiodarone without maintenance as prophylaxis against atrial fibrillation (AF) after valvular heart surgery. This was a prospective, randomized, double-blind controlled study on 94 patients listed for valvular heart surgery. The patients received either amiodarone, 3 mg/kg diluted in 100 ml of normal saline and started prior to making skin incision and administrated through venous line over a period of 30 min, or the same volume of normal saline infused in a similar fashion. The incidence of AF during the first 5 days after surgery was the main outcome measured. There was significant difference in favor of the amiodarone group regarding restoration of sinus rhythm after aortic cross-clamp removal, number of patients requiring cardioversion, incidence of AF and the time elapsed before incidence of it postoperatively (P values = 0.02, 0.04, 0.02, 0.02, respectively). There was no difference in hospital mortality, major postoperative morbidity, intensive care unit (ICU) stay or hospital stay. Amiodarone prophylaxis in a single intraoperative dose was significantly effective in prevention of new-onset postoperative AF after valvular heart surgery. This amiodarone dose is well tolerated and not associated with postoperative complications.

Amiodarone Significantly Decreases Atrial Fibrillation in Patients Undergoing Surgery for Lung Cancer

Postoperative atrial fibrillation occurs in 5% to 65% of patients undergoing thoracic surgery. Although postoperative atrial fibrillation often is regarded as a temporary, benign, operation-related problem, it is associated with a twofold to threefold increase in risk of adverse events, including transient or permanent stroke, acute myocardial infarction, and death. A total of 254 consecutively eligible enrolled patients undergoing surgery for lung cancer were included in this randomized, controlled, double-blinded trial. Patients received 300 mg of amiodarone or placebo intravenously over 20 minutes immediately after surgery and an oral dose of 600 mg of amiodarone or placebo twice daily during the first 5 postoperative days. The patients in the amiodarone prophylaxis group had a reduction in the risk of atrial fibrillation of 23% (12 to 31); number needed to treat was 4.4 (3.1 to 7.8). A total of 38 in the control group and 11 in the amiodarone group experienced atrial fibrillation (p<0.001). Adverse effects were observed in 10 patients equally distributed in both trial arms. Postoperative prophylaxis with a high dose of oral amiodarone after an intravenous bolus infusion is a safe, practical, feasible, and effective regimen for patients with lung cancer undergoing surgery. It significantly reduced the incidence of postoperative atrial fibrillation.

The rationale and design of the minocycline plus amiodarone versus amiodarone alone (MINAA) trial for the prevention of atrial fibrillation after cardiac surgery

Objectives: Amiodarone administration is presently considered in the prevention of new-onset postoperative atrial fibrillation (PAF) after cardiac operations, but relapse of PAF requiring anticoagulation therapy at hospital discharge is prevalent despite amiodarone prophylaxis. PAF is also associated with increased morbidity and mortality including complications resulting from long-term anticoagulation therapy. Currently, the most effective therapy to prevent PAF after cardiac surgery remains undetermined. Inflammatory mechanisms may be partly responsible for PAF. Minocycline, a tetracycline antibiotic, has specifically an atrial myocytes anti-apoptotic effect, decreases right atrial tissue inflammation and oxidative stress activity. These observations led to this trial’s hypothesis that the addition of minocycline to amiodarone may favorably affect suppression of PAF. Methods: This trial compares the efficacy and safety of minocycline plus amiodarone versus amiodarone alone, in the prevention of PAF among adult patients undergoing cardiac procedures. All patients receive Beta-blocker agent. The primary outcome is PAF occurrence. Secondary outcomes include thromboembolic stroke, need for pharmacologic or electric cardioversion, mediastinal exploration for sepsis or for anticoagulation-related bleeding, serious drug side effects, length of hospital stay and 30-day mortality from cardiovascular causes. Results: This is an ongoing prospective single center randomized controlled clinical trial. Conclusion: The trial provides information on the comparative effectiveness of this low-risk prevention therapy of PAF that could be integrated in clinical practice. (Clinicaltrials.gov number, NCT 01422148).

Atrial Fibrillation Predicts Worse Long Time Prognosis after CABG – A 6-Year Survival Analysis

Background: Postoperative atrial fibrillation occurs in 5% - 65% of patients undergoing cardiac surgery. Although postoperative atrial fibrillation is often regarded as a temporary, benign, operation-related problem, it is associated with a two- to threefold increased risk of adverse events, including permanent or transient stroke, acute myocardial infarction, and death. Methods: Two hundred and fifty eligible consecutively enrolled coronary artery bypass grafting patients were included in the randomized, controlled, double-blinded trial RASCABG. That study showed a safe, practical, feasible, and effective prophylactic amiodarone regimen, which significantly decreased the risk of atrial fibrillation with 14% (5.0 - 24) from 26% to 11%, with the number needed to treat 6.9 (4.2 - 20). This study is a 6-year follow-up study regarding the long-term prognostic factor of postoperative atrial fibrillation, amiodarone prophylaxis and diabetes mellitus. Results: The long-term 6-year mortality risk of postoperative atrial fibrillation was 31% equally distributed among patients in the active and in the placebo prophylactic group. The 6-year mortality risk in the sinus rhythm group was 18% likewise equally distributed, whereas the 6-year mortality risk in the background population was approximately 8%. The 6-year mortality risk of diabetes mellitus was 33% equally distributed, whereas the excluded off pump coronary artery bypass group experiences an increased 6-year mortality risk of 47%. Conclusions: Postoperative prophylaxis with a high dose of oral amiodarone after an intravenous bolus infusion is a safe, practical, feasible, and effective regimen for Coronary Artery Bypass Grafting patients in a 6-year long-term perspective. Atrial fibrillation and diabetes mellitus is correlated to increased mortality risk.

P-08 Amiodarone prophylaxis for ventricular arrhythmias during aortic valve replacement

Ventricular fibrillation accounts for 20% of the mortality after aortic valve replacement and the second most common cause of death. Several studies have shown reduction in the incidence of atrial fibrillation with prophylactic amiodarone. This study examines the role of amiodarone prophylaxis for ventricular arrhythmias during aortic valve replacement.

Preoperative Statin use is not Associated with a Reduced Risk of Atrial Fibrillation After Cardiac Surgery.

Introduction: Postoperative atrial fibrillation (POAF) is prevalent after cardiac surgery and associated with significant morbidity and costs. Statins are commonly used in this population and may be a preventative strategy for PAOF. We wished to examine the effect of preoperative statin use on the risk of POAF after cardiac surgery. Methods: A retrospective, observational study was conducted using data from 489 adult patients who underwent cardiac surgery at a single institution. Univariate analyses and unconditional logistic regression were used to determine the impact of preoperative statin use on the probability of developing POAF, while controlling for the baseline risk of POAF and the use of amiodarone prophylaxis (AMP). A baseline risk index was calculated for each patient using a previously validated model. Patients with chronic atrial fibrillation or missing data were excluded. Results: Mean patient age was 63 (SD=13) years, 73% were male, 68% underwent isolated coronary artery bypass grafting, 16% underwent isolated valve surgery, with 13% underwent combined CABG and valve surgeries, and 3% underwent other forms of cardiac surgery. POAF occurred in 27% of patients receiving statins and 24% of those not receiving statins (p=0.3792). After controlling for baseline risk of POAF and the use of AMP, we found that preoperative statins were not associated with reductions in POAF (OR=1.19, 95%CI=0.782-1.822, p=0.4118). Conclusions: Multiple factors impact the development of POAF after cardiac surgery including patient demographics, comorbidities, surgical type, and concomitant medications. In this study, after adjustment for these factors the preoperative use of statins did not significantly influence the development of POAF.

Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Prevention and Treatment of Atrial Fibrillation Following Cardiac Surgery

Postoperative atrial fibrillation and atrial flutter (POAF) are the most common complications of cardiac surgery that require intervention or prolong intensive care unit and total hospital stay. For some patients, these tachyarrhythmias have important consequences including patient discomfort/anxiety, hemodynamic deterioration, cognitive impairment, thromboembolic events including stroke, exposure to the risks of antiarrhythmic treatments, longer hospital stay, and increased health care costs. We conclude that prevention of POAF is a worthwhile exercise and recommend that the dominant therapy for this purpose be β-blocker therapy, especially the continuation of β-blocker therapy that is already in place. When β-blocker therapy is contraindicated, amiodarone prophylaxis is recommended. If both of these therapies are contraindicated, therapy with either intravenous magnesium or biatrial pacing is suggested. Patients at high risk of POAF may be considered for first-line amiodarone therapy, first-line sotalol therapy, or combination prophylactic therapy. The treatment of POAF may follow either a rate-control approach (with the dominant therapy being β-blocking drugs) or a rhythm-control approach. Anticoagulation should be considered if persistent POAF lasts >72 hours and at the point of hospital discharge. The ongoing need for any POAF treatment (including anticoagulation) should be reconsidered 6-12 weeks after the surgical procedure.

Magnesium sulphate and amiodarone prophylaxis for prevention of postoperative arrhythmia in coronary by-pass operations

BackgroundThe aim of this study was to investigate the use of prophylactic magnesium sulphate and amiodarone in treating arrhythmias that may occur following coronary bypass grafting operations.MethodsThe study population consisted of 192 consecutive patients who were undergoing coronary artery bypass grafting (CABG). Sixty-four patients were given 3 g of magnesium sulphate (MgSO4) [20 ml = 24.32 mEq/L Mg+2] in 100 cc of isotonic 0.9% solution over 2 hours intravenously at the following times: 12 hours prior to the operation, immediately following the operation, and on postoperative days 1, 2, and 3 (Group 1). Another group of 64 patients was given a preoperative infusion of amiodarone (1200 mg) on first post-operative day (Group 2). After the operation amiodarone was administered orally at a dose of 600 mg/day. Sixty-four patients in group 3 (control group) had 100 cc. isotonic 0.9% as placebo, during the same time periods.ResultsIn the postoperative period, the magnesium values were significantly higher in Group 1 than in Group 2 for all measurements. The use of amiodarone for total arrhythmia was significantly more effective than prophylactic treatment with magnesium sulphate (p = 0.015). There was no difference between the two drugs in preventing supraventricular arrhythmia, although amiodarone significantly delayed the revealing time of atrial fibrillation (p = 0.026). Ventricular arrhythmia, in the form of ventricular extra systole, was more common in the magnesium prophylaxis group. The two groups showed no significant differences in other operative or postoperative measurements. No side effects of the drugs were observed.ConclusionProphylactic use of magnesium sulphate and amiodarone are both effective at preventing arrhythmia that may occur following coronary by-pass operations. Magnesium sulphate should be used in prophylactic treatment since it may decrease arrhythmia at low doses. If arrhythmia should occur despite this treatment, intervention with amiodarone may be preferable.

Prevention of atrial fibrillation after coronary artery bypass grafting via atrial electromechanical interval and use of amiodarone prophylaxis

In our previous study, we defined a cut-off point of 120 ms for atrial electromechanical interval (AEMi) to determine the risk of atrial fibrillation (AF) occurrence. Accordingly, the present study sought to investigate whether or not a prophylactic perioperative administration of amiodarone could reduce the incidence of AF in a high-risk group (AEMi >120 ms) undergoing coronary artery bypass grafting (CABG). In this prospective, randomized study, 100 patients with AEMi >120 ms received either amiodarone (n=50) or placebo (n=50). The endpoints were AF occurrence after CABG and hospital and intensive care unit (ICU) lengths of stay after CABG. The incidence of postoperative AF was significantly higher in the placebo group than that of the amiodarone group (88% of patients in control group vs. 16% of patients in amiodarone group, P<0.0001). The prophylactic therapy with amiodarone significantly reduced the ICU length of stay (2.28+/-1.00 vs. 3.60+/-0.90 days, P<0.0001) and hospital length of stay (5.64+/-2.35 vs. 7.78+/-1.46 days, P<0.0001). The incidence of postoperative AF among patients with high AEMi was significantly reduced by a prophylactic amiodarone treatment, resulting in shorter ICU and hospital stays.

Amiodarone protects diabetics and non-diabetics undergoing coronary artery bypass grafting equally

Objective. To evaluate amiodarone prophylaxis in diabetics and non-diabetics. Further to clarify whether the risk of developing atrial fibrillation is higher for diabetics than non-diabetic patients, and to evaluate whether the diabetic status has any influence on the length of in-hospital stay. Design. Subgroup analysis within a randomized, controlled, double-blinded trial. Results. At 30 days of follow-up atrial fibrillation was equally frequent among diabetics (22%) and non-diabetics (17%) (p =0.41). The length of in-hospital stay for diabetics was prolonged with 25% (9%; 45%). The prophylactic amiodarone was found equally efficient in diabetics and non-diabetics, as the relative risk ratios were 1.2 (0.4–5.4) and 2.0 (0.3–12.5), respectively. Conclusions. Diabetics and non-diabetics had the same effect of the amiodarone prophylaxis regime. Atrial fibrillation developed equally among diabetics and non-diabetics, but the length of stay was prolonged for diabetics.