Amiodarone after surgical ablation for atrial fibrillation: Is it really necessary? A prospective randomized controlled trial

Ad, Niv; Holmes, Sari D.; Shuman, Deborah J.; Pritchard, Graciela; Miller, Casey

doi:10.1016/j.jtcvs.2015.07.034

Cited by 26 publications

(14 citation statements)

References 21 publications

(28 reference statements)

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“…13 Unless contraindicated, all patients received amiodarone at 200 mg twice a day for 5 days after surgery followed by 200 mg daily for 3 months to reduce the risk of early atrial arrhythmia recurrence. 14 If patients were in stable sinus rhythm at 3 months after surgery, amiodarone was recommended to be discontinued to allow for at least 6 weeks off the medication by the 6 months follow-up time point. Patients with an amiodarone allergy, history of side effects due to amiodarone, or other clinical contraindications were generally treated with sotalol or flecainide instead, which was prescribed for 3 months after surgery according to the same protocol.…”

Section: Methodsmentioning

confidence: 99%

Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation

Holmes

Massimiano

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Section: Methodsmentioning

confidence: 99%

Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation

Holmes

Massimiano

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Furthermore, it is reasonable to continue therapeutic anticoagulation until 24-hour monitoring demonstrates stable SR generally 2 to 6 months postoperatively. 78,79 Atrial Flutter Atrial flutter, like AF, can be seen in the immediate postoperative period following surgical antiarrhythmic surgery, with rates of SR increasing over the several months postoperatively. 75,80 During this time period, AAD and oral anticoagulant therapy are usually maintained as detailed above.…”

Section: Complications Of Surgical Management Of Af Incomplete Ablatimentioning

confidence: 99%

Treatment Complications of Atrial Fibrillation and Their Management

2020

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Atrial fibrillation (AF) is a rhythm disturbance defined by irregular, rapid electrical, and mechanical activation of the atria, which causes unsynchronized atrial contraction and promotes thromboembolism. AF is the most common sustained arrhythmia. Its prevalence and incidence are increasing due to aging and improved survival from acute heart diseases. This article is a review on AF management from both a surgical and catheter-based perspective. While both treatment approaches to AF have been shown to be successful in the management of AF, they are not without their own inherent complications. This article seeks to review some of these complications and help to guide treatment.

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“…Известные на сегодняшний день механизмы электрофизиологических изменений ткани сердца теоретически обосновывают возможность использования антиаритмических препаратов III класса для профилактики ПОФП [29]…”

Section: характеристика послеоперационного периодаunclassified

Comparative Effectiveness of Radiofrequency Pulmonary Vein Isolation Plus Amiodarone Therapy in Preventing Post-Coronary Artery Bypass Grafting Atrial Fibrillation

Ревишвили¹,

Попов²,

Плотников³

et al. 2020

Vestnik aritmologii

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Objective. To evaluate the effectiveness of epicardial bipolar radiofrequency ablation (RFA) of pulmonary vein ostia (PV) in comparison with its being combined with amiodarone administration for post-CABG atrial fibrillation (AF) prevention.Methods. A single-centre, prospective randomized study (PULVAB), including 96 CAD patients with no history of AF, was conducted between January 2015 and December 2018. Group 1 (control; n=34) had standard CABG alone. Group 2 (n=29) received RFA of PV as an adjunct to CABG for prevention of postoperative AF (POAF). Group 3 patients (n=33) had RFA at the time of CABG and were given amiodarone. Allocation was concealed using sequentiallynumbered opaque envelopes. The efficacy and safety of RFA concomitant with CABG were assessed, as both performed independently and combined with amiodarone administration, as well as intra-and postoperative course.Results. No differences were seen in operation length (p=0.937), cardiopulmonary bypass (CPB) or the aorta clamping times (р=0.377 and p=0.072, respectively). The study groups (CABG, CABG-RFA, CABG-RFA-amiodarone) did not differ statistically in the number of shunts placed - 3.17±0.61, 3.10±0.51 and 2.94±0,6 (p=0,121). No significant difference was noted in RFA duration between Groups 2 and 3 - 11.7±3.7 and 11.4±6.3 min, respectively (p=0,834).AF was found to occur most commonly at postoperative days two or four. The isolated CABG surgery group patients developed POAF most often of all (32,4%). The incidence of POAF was lower after RFA concomitant to CABG - 20.7% (р=0,29). A significant difference was identified in POAF incidence between Groups 1 and 3- 32.4% and 6.1%, respectively (p = 0.0065). Differences between Groups 2 and 3 proved not to be statistically significant (р= 0,086). Sinus rhythm in most of those who had developed arrhythmias was restored by pharmacological cardioversion except for three patients (one in each group). At discharge, 97.1% , 96.7% and 97% of the subjects in Groups 1, 2 and 3, respectively, exhibited sinus rhythm (p>0,05).There was no in-hospital mortality in any of the groups. Neither were there any wound complications, reoperations, perioperative myocardial infarction or cerebral circulatory disorders observed. No difference was revealed in the severity and frequency of renal or respiratory failure. The mechanical lung ventilation time and duration of stay in the ICU in the isolated CABG group were shown to be increased as compared with the CABG-RFA and CABG-RFA-amiodarone groups (p<0.05).Conclusion. The evidence from the pilot study (PULVAB) suggests that bipolar ablation of PV does not significantly complicate CABG, while being combined with amiodarone administration for prevention of rhythm disorders it significantly reduces the incidence of POAF. The in-hospital incidence of POAF tended to decrease, which was not statistically significant, though. Evaluating the efficacy of RFA concomitant with CABG, as performed independently, invites further investigation with more data analysis.

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Amiodarone after surgical ablation for atrial fibrillation: Is it really necessary? A prospective randomized controlled trial

Abstract: NCT01416935.

Cited by 26 publications

References 21 publications

Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation

Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation

Treatment Complications of Atrial Fibrillation and Their Management

Comparative Effectiveness of Radiofrequency Pulmonary Vein Isolation Plus Amiodarone Therapy in Preventing Post-Coronary Artery Bypass Grafting Atrial Fibrillation

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