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Ann Thorac Surg 2003;75:223-230
© 2003 The Society of Thoracic Surgeons
a Division of Cardiovascular and Thoracic Surgery, Mayo Clinic, Scottsdale, Arizona, USA
b Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
* Address reprint requests to Dr Lanza, Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ85054, USA
Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
BACKGROUND: Atrial fibrillation after pulmonary resection increases morbidity and costs. To evaluate the efficacy of low-dose oral amiodarone (LDOA) as prophylaxis for atrial fibrillation after pulmonary resection, we reviewed all patients 60 years or older having pulmonary resections by thoracotomy in a 30-month period.
METHODS: We identified 31 patients who received prophylactic LDOA (200 mg by mouth every 8 hours) while hospitalized and 52 patients who received no prophylactic treatment. The groups were comparable for sex, age, comorbidities, and surgical procedure.
RESULTS: Twenty of 83 patients (24%) had postoperative atrial fibrillation: 17 of 52 patients (33%) without prophylaxis and 3 of 31 (9.7%) with prophylaxis (odds ratio, 0.221; 95% confidence interval, 0.059 to 0.829; p = 0.0253). The median total hospital charge was $30,800 (range, $20,400–$96,900) for 50 patients without prophylaxis and $26,700 (range, $11,000–$55,900) for 31 patients with prophylaxis (p = not significant). Patients receiving LDOA had lower accumulated charges per day of hospital stay (p = 0.0011).
CONCLUSIONS: LDOA prophylaxis significantly reduces the incidence of atrial fibrillation after pulmonary resection. Its use in this population may be cost-effective. Results of this pilot study provide a rationale for a prospective randomized trial.
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