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Original Articles: General Thoracic

A Randomized Trial Evaluating Amiodarone for Prevention of Atrial Fibrillation After Pulmonary Resection

^a Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Purdue University, Indianapolis, Indiana
^b Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
^d Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
^e Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana
^c Department of Pharmacy, Indiana University Hospital of Clarian Health Partners, Indianapolis, Indiana

Accepted for publication April 21, 2009.

^_* Address correspondence to Dr Tisdale, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Purdue University, W7555 Myers Bldg, WHS, 1001 W 10th St, Indianapolis, IN 46202 (Email: jtisdale{at}iupui.edu).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Atrial fibrillation (AF) occurs commonly after anatomic pulmonary resection. In this study, the efficacy of amiodarone for prevention of post–pulmonary resection AF was investigated.

Methods: One hundred thirty patients undergoing lobectomy, bilobectomy, or pneumonectomy were randomly assigned prospectively to receive amiodarone (n = 65) or no prophylaxis (control group, n = 65). The amiodarone group received 1,050 mg by continuous intravenous infusion over 24 hours, initiated at the time of anesthesia induction, followed by 400 mg orally twice daily until hospital discharge or for a maximum of 6 days. The primary endpoint was AF requiring treatment during hospitalization. Secondary endpoints included postoperative length of hospital and intensive care unit stays.

Results: There were no significant differences between the amiodarone and control groups in demographics, comorbid conditions, extent of pulmonary resection, or preoperative or postoperative use of β-blockers or calcium-channel blockers. The incidence of AF was lower in the amiodarone group than in the control group (13.8% versus 32.3%, p = 0.02; relative risk reduction = 57%). There was no difference between the amiodarone and control groups in median length of hospital stay (7 versus 8 days, p = 0.79), but median length of intensive care unit stay was shorter in the amiodarone group (46 versus 84 hours, p = 0.03). There was no significant difference between the amiodarone and control groups in the incidence of pulmonary complications or other adverse effects.

Conclusions: Amiodarone prophylaxis significantly reduces the incidence of AF after anatomic pulmonary resection, and is associated with a significant reduction in length of intensive care unit stay.