| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1997;63:1374-1381
© 1997 The Society of Thoracic Surgeons
Departments of Anesthesiology and Critical Care Medicine, Medicine, Surgery, and Biostatistics, Memorial Sloan-Kettering Cancer Center and Cornell University Medical College, New York, New York
Background. This prospective study was designed to determine whether diltiazem is superior to digoxin for the prophylaxis of supraventricular dysrhythmias (SVD) after pneumonectomy or extrapleural pneumonectomy (EPP) and to assess the influence of these drugs on perioperative cardiac function.
Methods. Seventy consecutive patients without previous SVD were randomly allocated immediately after pneumonectomy or EPP to receive diltiazem (n = 35) or digoxin (n = 35). Diltiazem-treated patients received a slow intravenous loading dose of 20 mg, followed by 10 mg intravenously every 4 hours for 24 to 36 hours, then 180 to 240 mg orally daily for 1 month. Digoxin-treated patients received a 1-mg intravenous loading in the first 24 to 36 hours, then 0.125 to 0.25 mg orally daily for 1 month. A concurrent prospective cohort of 40 patients without previous SVD, who did not participate in the study and underwent pneumonectomy or EPP without prophylaxis, served as a comparison group for SVD occurrence. Serial Doppler echocardiograms were performed to assess cardiac function and all patients were continuously monitored with Holter recorders for 3 days. Data were analyzed by intent-to-treat.
Results. In patients undergoing standard or intrapericardial pneumonectomy, diltiazem prevented the overall incidence of postoperative SVD when compared with digoxin, 0 of 21 patients versus 8 of 25 patients, respectively, p < 0.005. When EPP patients were included in the analysis, diltiazem decreased the incidence of all SVD from 11 of 35 patients (31%) to 5 of 35 patients (14%) when compared with digoxin, p = 0.09. Digoxin-treated patients had a similar incidence of all SVD (31%) as concurrent controls (11 of 40 patients [28%]). The two treated groups did not differ in right or left atrial size, left ventricular ejection fraction, or right heart pressure. When all patients were combined, those in whom SVD developed were significantly older (65 ± 12 years versus 55 ± 11 years, p = 0.004) and had a longer median hospital stay (9 versus 6 days, p = 0.03), when compared with those in whom SVD did not develop, respectively. The subset of patients undergoing EPP had a greater incidence of atrial fibrillation and electrocardiographic changes suggestive of postoperative pericarditis than all other pneumonectomy patients.
Conclusions. Diltiazem was both safe and more effective than digoxin in reducing the overall incidence of SVD after standard or intrapericardial pneumonectomy. Digoxin therapy had no effect on the incidence of postoperative SVD and is not recommended for prophylaxis of SVD. Dysrhythmias after pneumonectomy or EPP occur in older patients and are associated with a greater length of hospital stay.
This article has been cited by other articles:
|
|
 |
|
  M. D. Kertai, C. M. Westerhout, K. S. Varga, G. Acsady, and J. Gal Dihydropiridine calcium-channel blockers and perioperative mortality in aortic aneurysm surgery Br. J. Anaesth., October 1, 2008; 101(4): 458 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Dunning, T. Treasure, M. Versteegh, S. A.M. Nashef, and on behalf of the EACTS Audit and Guidelines Commit Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 852 - 872. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Sedrakyan, T. Treasure, J. Browne, H. Krumholz, C. Sharpin, and J. van der Meulen Pharmacologic prophylaxis for postoperative atrial tachyarrhythmia in general thoracic surgery: Evidence from randomized clinical trials J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 997 - 1005. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Shrivastava, B. Nyawo, J. Dunning, and G. Morritt Is there a role for prophylaxis against atrial fibrillation for patients undergoing lung surgery? Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 656 - 662. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Amar, H. Zhang, S. Miodownik, and A. H. Kadish Competing autonomic mechanisms precedethe onset of postoperative atrial fibrillation J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1262 - 1268. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. N. Wijeysundera and W. S. Beattie Calcium Channel Blockers for Reducing Cardiac Morbidity After Noncardiac Surgery: A Meta-Analysis Anesth. Analg., September 1, 2003; 97(3): 634 - 641. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. De Decker, P. G. Jorens, and P. Van Schil Cardiac complications after noncardiac thoracic surgery: an evidence-based current review Ann. Thorac. Surg., April 1, 2003; 75(4): 1340 - 1348. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. N. Foroulis, C. Kotoulas, H. Lachanas, G. Lazopoulos, M. Konstantinou, and A. G. Lioulias Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy period: a study on 259 pneumonectomies Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 384 - 389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Lanza, A. I. Visbal, P. A. DeValeria, A. R. Zinsmeister, N. N. Diehl, and V. F. Trastek Low-dose oral amiodarone prophylaxis reduces atrial fibrillation after pulmonary resection Ann. Thorac. Surg., January 1, 2003; 75(1): 223 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Amar, H. Zhang, and N. Roistacher The Incidence and Outcome of Ventricular Arrhythmias After Noncardiac Thoracic Surgery Anesth. Analg., September 1, 2002; 95(3): 537 - 543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Amar, P. M. Heerdt, R. J. Korst, H. Zhang, and H. Nguyen The Effects of Advanced Age on the Incidence of Supraventricular Arrhythmias After Pneumonectomy in Dogs Anesth. Analg., May 1, 2002; 94(5): 1132 - 1136. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Amar and M. Fleisher Diltiazem Treatment Does Not Alter Renal Function After Thoracic Surgery Chest, May 1, 2001; 119(5): 1476 - 1479. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Amar, N. Roistacher, V. W. Rusch, D. H. Y. Leung, I. Ginsburg, H. Zhang, M. S. Bains, R. J. Downey, R. J. Korst, and R. J. Ginsberg Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery J. Thorac. Cardiovasc. Surg., October 1, 2000; 120(4): 790 - 798. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Ciriaco, P. Mazzone, B. Canneto, and P. Zannini Supraventricular arrhythmia following lung resection for non-small cell lung cancer and its treatment with amiodarone Eur. J. Cardiothorac. Surg., July 1, 2000; 18(1): 12 - 16. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Nattel Ionic Determinants of Atrial Fibrillation and Ca2+ Channel Abnormalities : Cause, Consequence, or Innocent Bystander? Circ. Res., September 3, 1999; 85(5): 473 - 476. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Amar Perioperative Supraventricular Tachyarrhythmia Ann Intern Med, May 18, 1999; 130(10): 863 - 864. [Full Text] [PDF]
|
|
|
|
|
|
A. S. Coulson, S. E. Kopec, R. S. Irwin, and A. A. Conlan Temporary Pacing After Pneumonectomy Chest, April 1, 1999; 115(4): 1214 - 1214. [Full Text] [PDF]
|
|
|
|
|
|
C. D. Bayliff, D. R. Massel, R. I. Inculet, R. A. Malthaner, S. D. Quinton, F. S. Powell, and R. S. Kennedy Propranolol for the prevention of postoperative arrhythmias in general thoracic surgery Ann. Thorac. Surg., January 1, 1999; 67(1): 182 - 186. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Curtis, B. M. Parker, C. A. McKenney, C. C. Wagner-Mann, J. T. Walls, T. L. Demmy, and R. A. Schmaltz Incidence and predictors of supraventricular dysrhythmias after pulmonary resection Ann. Thorac. Surg., November 1, 1998; 66(5): 1766 - 1771. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Amar Postoperative Cardiac Arrhythmias: Prevention and Management Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1997; 1(3): 256 - 263. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
