Intraoperative Administration of Amiodarone for Prophylaxis Against Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Postoperative atrial fibrillation is a common complication after coronary artery bypass grafting and may increase morbidity, intensive care stay, and hospital burden. Pharmacological prophylaxis with amiodarone may reduce perioperative rhythm disturbances in cardiac surgical patients. Objective: To evaluate the efficacy of intraoperative intravenous amiodarone in preventing postoperative atrial fibrillation and other perioperative arrhythmias in patients undergoing coronary artery bypass grafting. Methods: This prospective randomized controlled study was conducted at the Department of Cardiac Surgery, Chaudhry Pervaiz Elahi Institute of Cardiology, Wazirabad, over one year from November 2024 to November 2025. A total of 150 patients undergoing elective on-pump coronary artery bypass grafting were randomly allocated into two equal groups of 75 patients each. Patients in the amiodarone group received intraoperative intravenous amiodarone before aortic cross-clamp release, while patients in the control group received placebo. The primary outcome was the development of postoperative atrial fibrillation within the first five postoperative days. Secondary outcomes included ventricular arrhythmias, need for defibrillation or cardioversion, duration of mechanical ventilation, intensive care unit stay, total hospital stay, postoperative complications, and in-hospital mortality. Data were analyzed using SPSS. Categorical variables were compared using the chi-square or Fisher’s exact test, while continuous variables were compared using the independent sample t-test or Mann–Whitney U test, as appropriate. A p-value ≤0.05 was considered statistically significant. Results: Postoperative atrial fibrillation occurred significantly less frequently in the amiodarone group than in the control group (14.7% vs. 34.7%, p=0.004). The amiodarone group also showed significantly lower rates of ventricular fibrillation (9.3% vs. 24.0%, p=0.015), ventricular tachycardia (6.7% vs. 17.3%, p=0.041), premature ventricular contractions (13.3% vs. 28.0%, p=0.027), and requirement for electrical cardioversion (6.7% vs. 18.7%, p=0.026). Patients receiving amiodarone had significantly shorter duration of mechanical ventilation, intensive care unit stay, and total hospital stay. No statistically significant differences were observed between the groups regarding postoperative myocardial infarction, in-hospital mortality, or major adverse hemodynamic effects. Conclusion: Intraoperative intravenous amiodarone significantly reduced postoperative atrial fibrillation and other perioperative ventricular arrhythmias in patients undergoing elective on-pump coronary artery bypass grafting. Its use was associated with shorter postoperative recovery time and hospital stay without a significant increase in adverse effects, supporting its role as an effective prophylactic strategy in selected cardiac surgical patients.