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Ann Thorac Surg 2007;83:1326-1331
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Practical Regimen for Amiodarone Use in Preventing Postoperative Atrial Fibrillation

^a Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Skejby Sygehus, Aarhus University Hospital, Aarhus N, Denmark
^c Department of Intensive Care, Skejby Sygehus, Aarhus University Hospital, Aarhus N, Denmark
^b Department of Clinical Epidemiology & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus C, Denmark

Accepted for publication September 19, 2006.

^_* Address correspondence to Dr Zebis, Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Skejby Sygehus, Aarhus University Hospital, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark (Email: lrz{at}post.tele.dk).

Background: Postoperative atrial fibrillation occurs in 5% to 65% of patients undergoing cardiac surgery. Although postoperative atrial fibrillation is often regarded as a temporary, benign, operation-related problem, it is associated with a twofold to threefold increase in risk of adverse events, including permanent or transient stroke, acute myocardial infarction, and death.

Methods: This randomized, controlled, double-blinded trial included 250 eligible consecutively enrolled patients undergoing coronary artery bypass grafting (CABG). They received 300 mg of amiodarone/placebo administered intravenously over 20 minutes on the first postoperative day and an oral dose of 600 mg of amiodarone or placebo twice daily for the first 5 postoperative days.

Results: The patients in amiodarone prophylaxis experienced a reduction in risk of atrial fibrillation of 14% (95% confidence interval [CI], 5.0% to 24%), with the number needed to treat at 6.9 (95% CI, 4.2 to 20), and the results for symptomatic atrial fibrillation showed a risk reduction of 18% (95% CI, 9.4% to 26), with the number needed to treat at 5.7 (95% CI, 3.9 to 11). Of the patients who developed atrial fibrillation in the placebo group, 84% experienced a symptomatic attack versus only 43% in the amiodarone group.

Conclusions: Postoperative prophylaxis with a high dose of oral amiodarone after an intravenous bolus infusion is a safe, practical, feasible, and effective regimen for CABG patients. It significantly diminishes the occurrence of postoperative atrial fibrillation.

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				L. R. Zebis, T. D. Christensen, I. S. Kristiansen, and V. E. Hjortdal Amiodarone Cost Effectiveness in Preventing Atrial Fibrillation After Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., January 1, 2008; 85(1): 28 - 32. [Abstract] [Full Text] [PDF]