Preoperative Amiodarone as Prophylaxis against Atrial Fibrillation after Heart Surgery

doi:10.1056/NEJM199712183372501

Volume 337:1785-1791		December 18, 1997		Number 25

Preoperative Amiodarone as Prophylaxis against Atrial Fibrillation after Heart Surgery

Emile G. Daoud, M.D., S. Adam Strickberger, M.D., K. Ching Man, D.O., Rajiva Goyal, M.D., G. Michael Deeb, M.D., Steven F. Bolling, M.D., Francis D. Pagani, M.D., Cynthia Bitar, R.N., Marc D. Meissner, M.D., and Fred Morady, M.D.

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ABSTRACT

Background Atrial fibrillation occurs commonly after open-heartsurgery and may delay hospital discharge. The purpose of thisstudy was to assess the use of preoperative amiodarone as prophylaxisagainst atrial fibrillation after cardiac surgery.

Methods In this double-blind, randomized study, 124 patientswere given either oral amiodarone (64 patients) or placebo (60patients) for a minimum of seven days before elective cardiacsurgery. Therapy consisted of 600 mg of amiodarone per day forseven days, then 200 mg per day until the day of discharge fromthe hospital. The mean (±SD) preoperative total doseof amiodarone was 4.8±0.96 g over a period of 13 ±7 days.

Results Postoperative atrial fibrillation occurred in 16 ofthe 64 patients in the amiodarone group (25 percent) and 32of the 60 patients in the placebo group (53 percent) (P = 0.003).Patients in the amiodarone group were hospitalized for significantlyfewer days than were patients in the placebo group (6.5 ±2.6 vs. 7.9 ± 4.3 days, P = 0.04). Nonfatal postoperativecomplications occurred in eight amiodarone-treated patients(12 percent) and in six patients receiving placebo (10 percent,P = 0.78). Fatal postoperative complications occurred in threepatients who received amiodarone (5 percent) and in two whoreceived placebo (3 percent, P = 1.00). Total hospitalizationcosts were significantly less for the amiodarone group thanfor the placebo group ($18,375±$13,863 vs. $26,491±$23,837,P = 0.03).

Conclusions Preoperative oral amiodarone in patients undergoingcomplex cardiac surgery is well tolerated and significantlyreduces the incidence of postoperative atrial fibrillation andthe duration and cost of hospitalization.

Source Information

From the Division of Cardiology, Department of Internal Medicine (E.G.D., S.A.S., K.C.M., R.G., C.B., F.M.), and the Division of Thoracic Surgery, Department of Surgery (G.M.D., S.F.B., F.D.P.), University of Michigan Hospital, Ann Arbor; and the Division of Cardiology, Department of Internal Medicine, Harper Hospital, Wayne State University, Detroit (M.D.M.).

Address reprint requests to Dr. Daoud at the Midwest Cardiology Research Foundation, Riverside Methodist Hospital, 3545 Olentangy Rd., Rm. 325, Columbus, OH 43214.

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N Engl J Med 1998; 338:1383-1384, May 7, 1998. Correspondence

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