A comparison of amiodarone and digoxin for treatment of supraventricular arrhythmias after cardiac surgery

Abstract

Despite the widespread use of amiodarone in non-surgical patients, its role in the management of supraventricular tachyarrhythmias after cardiac surgery is not clear. We set out to compare the relative efficacy of amiodarone and digoxin in the management of atrial fibrillation and flutter in the early postoperative period. This prospective randomised trial comprised 30 patients, previously in sinus rhythm, who developed sustained atrial fibrillation or flutter following myocardial revascularisation, valve surgery or combined procedures. Amiodarone was administered as an intravenous loading dose followed by a continuous infusion. Digoxin was given as an intravenous loading dose followed by oral maintenance therapy. Electrocardiographic and haemodynamic monitoring was continued for 24 h after the commencement of treatment. There was a marked reduction in heart rate in both groups, mainly in the first 6 h, from 146 to 89 beats per minute in the amiodarone group and from 144 to 95 in the digoxin group. At the end of the 24 h, one of the 15 patients in the amiodarone group and 3 of the 15 patients in the digoxin group remained in atrial fibrillation. No patient in either group developed adverse reactions. We conclude that intravenous amiodarone therapy is safe and at least as effective as digoxin in the initial management of arrhythmias after cardiac surgery.

Assessment of new onset postcoronary artery bypass surgery atrial fibrillation: current practice pattern review and the development of treatment guidelines

“…Studies in the post-CABG population have compared digoxin with various antiarrhythmics with the primary outcome being conversion to NSR, rather than the effectiveness of rate control. Ironically, digoxin has been shown to be equally effective as the other agents in restoring NSR; this fact serves to reinforce the high rate of spontaneous conversion with post-CABG AF (17,19,34). Eight patients in this study were discharged on digoxin.…”

Intravenous amiodarone in intensive care

“…Cochrane et al [36] demonstrated that amiodarone was as safe and at least as effective as digoxin in restoring sinus rhythm and controlling heart rate in 30 patients with atrial fibrillation or flutter after cardiac surgery. Both decreased heart rate equally.…”

Management of atrial fibrillation after cardiac surgery

“…Cochrane et al compared digoxin to amiodarone for new‐onset post‐cardiac surgery AF or flutter in a randomised trial of 30 patients . They found no significant difference in terms of how many patients remained in AF 24 h after initiation of therapy (20 vs 6.67%, 3 vs 1 patient, P > 0.05) and noted that both agents were effective in reducing heart rate (144–95 vs 146–89, P > 0.05), especially within the first 6 h of therapy, and detected no major adverse reactions in either group.…”