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Ann Thorac Surg 2006;82:1927-1937
© 2006 The Society of Thoracic Surgeons

Reviews

Prophylactic Amiodarone for Prevention of Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis

Sean M. Bagshaw, MD, MSa,d,g, P. Diane Galbraith, BN, MSb,e,f, L. Brent Mitchell, MDb,e, Reg Sauve, MDd, Derek V. Exner, MD, MPHb,c,d,e, William A. Ghali, MD, MPHc,d,*

a Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
b Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
c Department of Medicine, University of Calgary, Calgary, Alberta, Canada
d Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
e Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
f Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada
g Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia

Accepted for publication June 12, 2006.

* Address correspondence to Dr Ghali, Faculty of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada. (Email: wghali{at}ucalgary.ca).

Amiodarone has been proposed to decrease atrial fibrillation after cardiac surgery. The literature was systematically reviewed for randomized trials comparing amiodarone with control for prevention of atrial fibrillation. Data were extracted on study characteristics, quality, and incidence of atrial fibrillation, cardiovascular outcomes, and length of hospitalization. Nineteen trials were included. Amiodarone reduced the odds ratio of atrial fibrillation (0.50; 95% confidence interval [CI]: 0.43 to 0.59, p < 0.0001), ventricular tachyarrhythmias (0.39; 95% CI: 0.26 to 0.58, p < 0.0001), and strokes (0.53; 95% CI: 0.30 to 0.92, p = 0.02). Amiodarone reduced hospital stay (0.6 days; 95% CI: 0.4 to 0.8, p < 0.0001). Amiodarone decreased atrial fibrillation, reduced perioperative ventricular tachyarrhythmias and strokes, and reduced duration of hospitalization. The current evidence supports recommending the routine use of perioperative amiodarone for cardiac surgery.




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