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Ann Thorac Surg 2004;77:1288-1292
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Indicators of atrial fibrillation risk in cardiac surgery patients on prophylactic amiodarone

James S. Kalus, PharmDb,c, C. Michael White, PharmDb,c, Michael F. Caron, PharmDf, Craig I. Coleman, PharmDb,c*, Hiroyoshi Takata, MDd, Jeffrey Kluger, MDa,e

a College of Medicine, University of Connecticut, Hartford, Connecticut, USA
b College of Pharmacy, University of Connecticut, Hartford, Connecticut, USA
c Hartford Hospital, Department of Pharmacy, Hartford, Connecticut, USA
d Hartford Hospital, Department of Cardiothoracic Surgery, Hartford, Connecticut, USA
e Hartford Hospital, Department of Cardiology, Hartford, Connecticut, USA
f University of Rhode Island College of Pharmacy and Rhode Island Hospital Department of Pharmacy, Providence, Rhode Island, USA

Accepted for publication September 15, 2003.

* Address reprint requests to Dr Coleman, Department of Pharmacy Practice, Pharmacoeconomic and Outcomes Studies Group, College of Pharmacy, University of Connecticut, Hartford Hospital—Drug Information Center, 80 Seymour St, Hartford, CT 06102, USA.
e-mail: ccolema{at}harthosp.org

BACKGROUND: Atrial fibrillation is a common complication of cardiothoracic surgery (coronary artery bypass graft surgery or cardiac valve repair or replacement). Although predictors of postoperative atrial fibrillation have been explored in patients not receiving prophylactic antiarrhythmic therapy, independent predictors of postoperative atrial fibrillation in patients receiving prophylactic amiodarone have not been elucidated.

METHODS: This was a substudy of a clinical trial evaluating the efficacy of an amiodarone regimen or an atrial-septal pacing strategy on the occurrence of postoperative atrial fibrillation. The association between the occurrence of postoperative atrial fibrillation and preoperative, intraoperative, and postoperative data from the total study population and the amiodarone and placebo subpopulations were explored using multiple logistic regression analysis.

RESULTS: The following clinical factors were independent predictors of postoperative atrial fibrillation in the total population: age (p < 0.001), history of atrial fibrillation (p = 0.021), diabetes mellitus (p = 0.008), and high-dose postoperative nonsteroidal antiinflammatory drug use (p = 0.038). Age (p = 0.016), history of mitral regurgitation (p = 0.029), heart failure (p = 0.010), and postoperative nonsteroidal antiinflammatory drug use (p = 0.038) were independent predictors when amiodarone was used, and age was the only predictor of postoperative atrial fibrillation (p = 0.024) among patients treated with placebo.

CONCLUSIONS: This subanalysis demonstrates some novel predictors of postoperative atrial fibrillation, including diabetes mellitus and postoperative nonsteroidal antiinflammatory drug use. We have also demonstrated that predictors of atrial fibrillation differ when prophylactic amiodarone is used.




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