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Amiodarone for Prevention of Postoperative AF in CAD s/p CABG

This study examines the effectiveness of amiodarone in preventing postoperative atrial fibrillation (AF) for patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG). The results show that low-dose intravenous amiodarone significantly reduces the incidence, ventricular rate, and duration of AF without increasing the risk of complications. The study also compares oral versus intravenous administration and perioperative versus postoperative prophylaxis.

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Amiodarone for Prevention of Postoperative AF in CAD s/p CABG

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  1. Does amiodarone work in prevention of postoperative AF for patients with CAD s/p CABG? 麻醉科R1楊美惠

  2. Post CABG AF • incidence rate: 10%-40%

  3. Previous associated studies • Hohnloser SH, Meinertz T, Dammbacher T, et al. Electrocardiographic and antiarrhythmic effects of intravenous amiodarone: results of a prospective, placebo-controlled study. Am Heart J 1991;121:89–95..

  4. Intravenous Amiodarone for Prevention of Atrial Fibrillation After Coronary Artery Bypass Grafting Shih-Huang LEE, MD, Che-Ming Chang, MD, Ming-Jen LU, MD, Ren-Jen Lee, Jun-Jack Cheng, MD, Chi-Ren Hung, MD, and Shih-Ann Chen, MD Divisions of Cardiology and Cardiovascular Surgery, Shin Kong Wu Ho-Su Memorial Hospital, and National Yang-Ming University, Taipei, Taiwan 2000 by the Society of Thoracic Surgeons Published by Elsevier Science Inc

  5. Prospective randomied controlled study

  6. Material and Methods • 150 Patients • Exclusion criteria-<20y/o, history of previous AF, concomitant operations such as valve replacement and aneurysmectomy, preoperative use of antiarrhythmic therapy other than digitalis, calcium-channel blockers and b-blockers, history of amiodarone side effects, use of amiodarone within 6 months, concomitant thyroid disease, abnormal liver function test results, pregnancy, preexisting bradycardia(<55BPM), uncontrolled severe heart failure.

  7. Hx, PE, Lab, CXR , 2D, Doppler and color echocardiograms • Study protocol~Timing:3 days before and 5 days after operation~Amiodarone group: loading dose of 150mg then 0.4mg/kg/hr ~Control group: 5%glucose infusions

  8. Results

  9. Conclusions • Perioperaitve low-dose intravenous amiodarone significantly reduces ~incidence ~ventricular rate ~duration • It is well tolerated and does not increase the risk of intraoperative or postoperative complications

  10. Modification • IV v.s. Oral form? • Perioperative v.s Postoperative?

  11. Postoperative Oral Amiodarone as Prophylaxis Against Atrial Fibrillation After Coronary Artery Surgery Alexandre Yazigi, MD, Pielly Rahbani, MD, Hicham Abou Zeid, MD, Samia Madi-Jebara, MD, Fadia Haddad, MD and Gemma Hayek, MD Journal of Cardiothoracic and Vascular Anesthesia, Vol 16, No5(October), 2002:P 603-606

  12. Study prococol • Post-OP <4hr admission to ICU • Sinus rhythm > 70 beats/min • Free from inotropic drug support • Randomized into 2 groups~ group 1: oral 15mg/kg, then 7mg/kg/d until discharge from hospital~ group 2: placebo

  13. Postoperative Atrial Fibrillation Endpoints

  14. Comparison

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