Emprego de altas doses de amiodarona via oral na reversão da fibrilação atrial no pós-operatório de cirurgia cardíaca

Abstract

Purpose -To report our experience using high dose oral amiodarone (1,800mg/day) for the reversion of atrial fibrillation to sinus rhythm in patients submitted to cardiac surgery.Methods -We retrospectively analyzed the records of 80 patients who had atrial fibrillation during the postoperative period after cardiac surgery, initially divided in two groups: group A, 28 patients that used amiodarone, and group B composed of patients receiving digoxin. The latter group was divided further in a third group (C), with 21 patients in which amiodarone was associated with digoxin if there was no reversion of the arrhythmia after 48 hours of treatment. The observed differences were considered significant at P<0.05.Results -Atrial fibrillation occurred in 19.4% of the patients submitted to surgery, predominating in males, 60 to 69 years-old. In group A there was reversion to sinus rhythm in 78.6% of the cases. In group B digoxin succeeded in 60%, and in group C 90% of the patients reverted to sinus rhythm.Conclusion -High dose oral amiodarone, alone or combined to digoxin, can be safe and effective for the treatment of atrial fibrillation after cardiac surgery. Key-words: amiodarone, atrial fibrillation, cardiac surgeryObjetivo -Relatar a experiência no emprego de altas doses de amiodarona via oral (1800mg/d) na reversão da fibrilação atrial (FA) em pacientes submetidos à cirurgia cardíaca.Métodos -Analisados, retrospectivamente, 80 pacientes que apresentaram FA no pós operatório de cirurgia cardíaca, constituindo 2 grupos: grupo A com 28 pacientes em uso de amiodarona e grupo B recebendo digital, sendo que este grupo foi subdividido no grupo C com 21 pacientes onde foi associada amiodarona, quando não houvesse reversão da arritmia em 48h. As diferenças foram consideradas significativas para um valor de P<0,05.Resultados -A FA esteve presente em 19,4% dos pacientes operados, com predomínio no sexo masculino e entre 60-69 anos. No grupo A, a reversão ocorreu em 78,6% dos casos, grupo B, o digital obteve sucesso em 60% das vezes e no grupo C, a taxa de sucesso foi de 90%.Conclusão -O uso de altas doses de amiodarona via oral, isolada ou em combinação com digital pode ser segura e eficaz no tratamento da FA em pós operatório de cirurgia cardíaca. Palavras

Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis

“…We identified seven observational studies that included a total of 1428 patients ( Supplementary File S6 ) [ 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. For rhythm control, five studies used amiodarone while two studies permitted choice between a class I or III anti-arrhythmic.…”

“…Supplementary file S5 describes the rhythm monitoring methods that were used in each trial. We identified seven observational studies that included a total of 1428 patients (Supplementary File S6) [27][28][29][30][31][32][33]. For rhythm control, five studies used amiodarone while two studies permitted choice between a class I or III anti-arrhythmic.…”