Abstract

Objective: Atrial fibrillation (AFib) is the most common arrhythmia complicating cardiac surgery and remains common despite improvements in surgical techniques and perioperative management. Due to its high risk for significant morbidity and mortality, AFib prophylaxis is very important to improve outcomes. The purpose of this study was to investigate the efficacy of lower-dose oral Amiodarone therapy protocol for the prevention of Postoperative Atrial fibrillation (POAF) in patient undergoing on-pump isolated Coronary Artery By-pass Grafting (CABG) with risk factors for the development of postoperative atrial fibrillation (POAF).

Methods: To investigate the role of lower - dose Amiodarone therapy for the prevention of POAF in high-risk patients, we conducted a prospective, randomized, placebo-controlled, single blind study. 120 patients, aged 65 years and older and with EF≤40% who underwent elective and initial isolated CABG were enrolled in this study. Patient in the treatment group received oral Amiodarone, 2.4 g over 3 preoperative days, followed by 200 mg once daily regimen, for at least 6 days postoperatively.

Results: The incidence of POAF in the in the Amiodarone -treated group was significantly lower compared to the control group (18,3% vs 38,3% p = 0.015), with a Relative Risk of 0.48 times (95% CI: 0.26-0.89) and an estimated Number- Needed -to- Treat of 5 patients to prevent one additional case of POAF. The overall Intensive Care Unit (ICU) and hospital Length of stay (LOS) was significantly lower in the Amiodarone group compared to the control group (48 ± 9.1 vs 55 ± 15.4, p = 0.003 and 7.5 ± 0.99 vs 8.2 ± 1.4, p = 0.002, respectively). Patients who developed POAF in the Amiodarone group compared to the control group had a significant lower duration of Afib (18.2 ± 4.9 vs 36.6 ± 8.1, p = 0.001) and a significant lower ventricular rate (71.1 ± 2.7 vs 93.9 ± 8.6, p = 0.001).

Conclusion: Lower dose of oral Amiodarone therapy, resulted effective for the prevention of POAF in the patient population aged 65 years and older, with EF≤40%, who underwent on-pump isolated elective CABG. This beneficial effect in the reduction of POAF incidence and duration is associated with significant shorter ICU and hospital LOS in the Amiodarone treated group and is achieved without adverse effects.

Keywords: Atrial Fibrillation; Post-op; Prevention; Cardiac Surgery; Amiodarone

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Citation

Citation: Juna Musa.,et al. “Low-dose Amiodarone in Prophylaxis of Atrial Fibrillation After Isolated On-pump Coronary Artery Bypass Surgery in Patients with Risk Factors for the Development of Postoperative Atrial Fibrillation". Acta Scientific Medical Sciences 7.1 (2023): 137-150.

Copyright

Copyright: © 2022 Juna Musa.,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.