INTRA-OPERATIVE ADMINISTRATION OF AMIODARONE AGAINST POST-OPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING ELECTIVE CARDIAC SURGERY

AK KHAN; FY PANNU; M AMIN; S IQBAL; S MUQEET

doi:10.54112/bcsrj.v2024i1.1414

Authors

AK KHAN Department of Cardiac Surgery, Pakistan Institute of Cardiology Lahore, Pakistan
FY PANNU Department of Cardiology, Mayo Hospital Lahore, Pakistan
M AMIN Department of Cardiology, Pakistan Kidney & Liver Institute & Research Lahore, Pakistan
S IQBAL Department of Cardiology, Rahbar Medical and Dental College Lahore, Pakistan
S MUQEET Department of Cardiology, Rahbar Medical and Dental College Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1414

Keywords:

Atrial fibrillation, Arrhythmia, Cardiac surgery, Heart

Abstract

Postoperative atrial fibrillation (AF) is a common complication following cardiac surgery, associated with increased morbidity, prolonged hospital stays, and higher healthcare costs. Amiodarone is frequently used as a prophylactic measure to reduce the incidence of AF, but its efficacy and safety in this context remain controversial. Objective: To assess the outcome of peri-operative amiodarone administration for the prevention of atrial fibrillation in patients undergoing elective cardiac surgery. Methods: A prospective study was conducted in the Cardiac Surgery Department of Punjab Institute of Cardiology, Lahore from November 2023 to November 2024. A total of 150 patients undergoing elective cardiac surgery at high risk of developing postoperative atrial fibrillation were selected. The cases group included 75 patients who were administered 400 mg amiodarone twice daily for 5 days before surgery and 5 days after surgery once a day. The control group included 75 patients who were administered placebo treatment. Cardiac surgeries were performed as per usual procedure without any changes. Results: Atrial fibrillation occurred in 30 (40%) patients in the control group and 27 (36%) patients in the cases group, however, this difference was not significant. The mean duration of AF in the control group was 12.5 hours as compared to 15.5 hours in cases, the difference was insignificant. None of the patients died in both groups as reported after 6 weeks follow-up. 6 (8%) patients in the cases group experienced stroke or TIA as compared to none in the control group. 24 (32%) patients in the control group experienced bleeding complications and 3 (4%) patients in the cases groups. Conclusion: No difference in clinical outcomes was observed by administration of amiodarone for prevention of post-op atrial fibrillation.

Downloads

Download data is not yet available.

References

Elliott AD, Middeldorp ME, Van Gelder IC, Albert CM, Sanders P. Epidemiology and modifiable risk factors for atrial fibrillation. Nature Reviews Cardiology. 2023;20(6):404-417.

Sagris M, Vardas EP, Theofilis P, Antonopoulos AS, Oikonomou E, Tousoulis D. Atrial fibrillation: pathogenesis, predisposing factors, and genetics. International journal of molecular sciences. 2021;23(1):6.

Bizhanov KA, Аbzaliyev KB, Baimbetov AK, Sarsenbayeva AB, Lyan E. Atrial fibrillation: Epidemiology, pathophysiology, and clinical complications (literature review). Journal of Cardiovascular Electrophysiology. 2023;34(1):153-165.

Jost N, Christ T, Magyar J. New strategies for the treatment of atrial fibrillation. Pharmaceuticals. 2021;14(9):926.

Lenhoff H, Järnbert-Petersson H, Darpo B, Tornvall P, Frick M. Mortality and ventricular arrhythmias in patients on d, l-sotalol for rhythm control of atrial fibrillation: A nationwide cohort study. Heart Rhythm. 2023;20(11):1473-1480.

Mujović N, Dobrev D, Marinković M, Russo V, Potpara TS. The role of amiodarone in contemporary management of complex cardiac arrhythmias. Pharmacological Research. 2020;151:104521.

Polintan ET, Monsalve R, Menghrajani RH, Sirilan KY, Nayak SS, Abdelmaseeh P, et al. Combination prophylactic amiodarone with beta-blockers versus beta-blockers in atrial fibrillation after cardiac surgery: A systematic-review and meta-analysis. Heart & Lung. 2023;62:256-263.

Ray WA, Chung CP, Stein CM, Smalley W, Zimmerman E, Dupont WD, et al. Risk for bleeding-related hospitalizations during use of amiodarone with apixaban or rivaroxaban in patients with atrial fibrillation: a retrospective cohort study. Annals of internal medicine. 2023;176(6):769-778.

Shurrab M, Jackevicius CA, Austin PC, Tu K, Qiu F, Singh SM, et al. Association between concurrent use of amiodarone and DOACs and risk of bleeding in patients with atrial fibrillation. The American Journal of Cardiology. 2023;186:58-65.

Lin S-Y, Liu Y-B, Ho L-T, Peng Y-F, Kuo C-H, Tang S-C, et al. Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation. Journal of the Formosan Medical Association. 2023;122(8):776-784.

Rasmussen PV, Dalgaard F, Gislason GH, Torp-Pedersen C, Piccini J, D’Souza M, et al. Amiodarone treatment in atrial fibrillation and the risk of incident cancers: a nationwide observational study. Heart Rhythm. 2020;17(4):560-566.

Parent S, Amant JS, Remortel SV, Kahn S, Vaka R, Courtman D, et al. Atrial Fibrosis and Inflammation in Postoperative Atrial Fibrillation: Comparative Effects of Amiodarone, Colchicine, or Exosomes. Clinical Electrophysiology. 2024;10(6):1037-1049.

Taha HS, Youssef G, Omar RM, El Din AMK, El Din AAS, Meshaal MS. Efficacy and speed of conversion of recent onset atrial fibrillation using oral propafenone versus parenteral amiodarone: a randomized controlled comparative study. Indian Heart Journal. 2022;74(3):212-217.

Caspersen E, Guinot P-G, Rozec B, Oilleau J-F, Fellahi J-L, Gaudard P, et al. Comparison of landiolol and amiodarone for the treatment of new-onset atrial fibrillation after cardiac surgery (FAAC) trial: study protocol for a randomized controlled trial. Trials. 2023;24(1):353.

Tsioufis P, Tsiachris D, Doundoulakis I, Kordalis A, Antoniou C-K, Vlachakis PK, et al. Rationale and Design of a Randomized Controlled Clinical Trial on the Safety and Efficacy of Flecainide versus Amiodarone in the Cardioversion of Atrial Fibrillation at the Emergency Department in Patients with Coronary Artery Disease (FLECA-ED). Journal of clinical medicine. 2023;12(12):3961.