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Ann Thorac Surg 2002;74:69-74
© 2002 The Society of Thoracic Surgeons
a Divisions of Cardiology and Drug Information, Hartford Hospital, Hartford, USA
b University of Connecticut Schools of Pharmacy and Medicine, Storrs and Farmington, Connecticut, USA
Accepted for publication March 11, 2002.
* Address reprint requests to Dr Kluger, Arrhythmia Service, Division of Cardiology, 80 Seymour St, Hartford Hospital, Hartford, CT 06102-5037, USA
e-mail: jkluger{at}harthosp.org
Background. This study compares the ability of two oral amiodarone regimens to reduce the risk of atrial fibrillation (AF) as compared with the placebo among elderly open heart surgery (OHS) patients receiving ß blockade.
Methods. This is a randomized, double-blinded, placebo-controlled trial of 220 patients undergoing OHS. Patients (average age, 73 years) received 7 g of oral amiodarone more than 10 days starting 5 days before OHS (slow load; n = 56), a 6 g oral amiodarone regimen more than 6 days starting 1 day before OHS (fast load; n = 64), or matching placebo in one of the two previously mentioned regimens (n = 100).
Results. Patients receiving the slow load amiodarone regimen had a significant reduction in the risk of AF (48.4%; p = 0.013), AF lasting more than 24 hours (76.5%; p = 0.003), symptomatic AF (90.0%; p = 0.002), and recurrent AF (64.5%; p = 0.025) as compared with the placebo. Patients receiving the fast load amiodarone regimen had significant reductions in the risk of AF lasting more than 24 hours (52.6%; p = 0.038) and symptomatic AF (65.0%; p = 0.024), but the incidence of any AF or any recurrence of AF only showed a trend toward significance (34.0% and 45.5%; p = 0.054 and 0.09, respectively).
Conclusions. Oral amiodarone in a slow loading regimen provides significant suppression of all AF factors and can be used when a patient has started it at least 5 days before OHS. If a patient has less than 5 days before OHS, the fast loading regimen is an efficacious alternative as it provides significant benefits in preventing AF from lasting more than 24 hours and for preventing symptomatic AF. Both regimens were well tolerated and safe in elderly patients receiving ß blockade according to the hospital’s standard protocol.
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