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Ann Thorac Surg 1989;48:232-234
© 1989 The Society of Thoracic Surgeons

Articles

Prevention of arrhythmias by flecainide after noncardiac thoracic surgery

A. Borgeat, MD*, J. Biollaz, MD, M. Bayer-Berger, MD, L. Kappenberger, MD, G. Chapuis, MD, R. Chioléro, MD

Departments of Anesthesiology and Reanimation, Clinical Pharmacology, Cardiology, and Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Accepted for publication February 20, 1989.

* Address reprint requests to Dr Borgeat, Department of Anesthesiology and Reanimation, Centre Hospitalier Universitaire Vaudois, CH 1011 Lausanne-CHUV, Switzerland.

Cardiac arrhythmias are a frequent complication after thoracic operations. The prophylactic value of flecainide administered as a constant-rate, intravenous infusion (0.15 mg/kg/h) after a loading dose (2 mg/kg) was tested in a randomized, placebo-controlled study in 30 patients using Holter monitoring during the first 72 hours after operation. A high incidence of atrial and complex ventricular arrhythmias was observed in the placebo-treated group, with a clear predominance in patients undergoing left thoracotomy. Antiarrhythmic drugs had to be added in 6 patients in the placebo-treated group (n = 16), but in none in the flecainide-treated group (n = 14) (p < 0.01). The preventive effect of flecainide was observed at serum concentrations in the middle of the therapeutic range (409 ng/mL) without side effects. It is concluded that flecainide administration effectively reduced or prevented cardiac arrhythmias after thoracic operations.




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