Short-duration oral amiodarone for prevention of atrial fibrillation post heart surgery

Carter, William H.; Trotter, Christopher; Kowalski, T E; Modak, Asmita; Siddiqui, Yahya; Davis, Elaine; Sampath, Ranathan; Khan, Jamal H.

doi:10.1016/j.jelectrocard.2012.07.005

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…In a study where prophylactic amiodarone was started the night before surgery and continued for 4 to 6 days postoperatively following cardiac surgery, the incidence of AF was significantly decreased irrespective of concomitant administration of BBs. 30 Even a single dose of intravenous amiodarone administered intraoperatively has been shown to reduce the incidence of post–cardiopulmonary bypass arrhythmia in patients undergoing valve replacement surgery. 31 It is also unclear if amiodarone is more efficacious than BBs in preventing AF.…”

Section: Medical Managementmentioning

confidence: 99%

Management of Postoperative Atrial Fibrillation in Cardiac Surgery Patients

Raiten

Patel

Gutsche

2015

Semin Cardiothorac Vasc Anesth

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Postoperative atrial fibrillation (AF) is a common arrhythmia following cardiac surgery and contributes to patient morbidity, prolonged hospital stay, and increased financial costs. The risk of postoperative AF may increase based on patient characteristics or events that occur intraoperatively or postoperatively. An understanding of these risks may be helpful in identifying which patients would benefit from prevention strategies. Acute AF presentation may range from completely indolent to rapidly progressing hemodynamic instability. Patients without hemodynamic compromise can be managed conservatively with rate control or initiation of antiarrhythmic medications. Patients with significant hemodynamic instability should undergo direct current cardioversion. In the postoperative period, it is reasonable to initiate anticoagulation after 48 hours of sustained AF or frequent episodes of postoperative AF.

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Section: Medical Managementmentioning

confidence: 99%

Management of Postoperative Atrial Fibrillation in Cardiac Surgery Patients

Raiten

Patel

Gutsche

2015

Semin Cardiothorac Vasc Anesth

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“…1, and 47 of them studied postoperative arrhythmias specifically after cardiac surgery[12,14-33,35-45,47-52,54,55,57- 61]. Of those 47, there were 44 that studied supraventricular tachyarrhythmias, ultimately constituting 84.6% of the total studies analyzed[12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]32,33,[35][36][37][39][40][41][42][43][44][45][47][48][49][50]52,54,55,[57][58][59][60][61][62]. Further complicating the impact of postoperative AFib is the extended length of hospital stay, which proves to be an indicator of increased healthcare expenditures as well as patient morbidity[62].…”

mentioning

confidence: 99%

Navigating the Incidence of Postoperative Arrhythmia and Hospitalization Length: The Role of Amiodarone and Other Antiarrhythmics in Prophylaxis

Yarlagadda,

Abutineh,

Datir

et al. 2024

Cureus

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Antiarrhythmic drugs play a pivotal role in managing and preventing arrhythmias. Amiodarone, classified as a class III antiarrhythmic, has been used prophylactically to effectively prevent atrial fibrillation postoperatively in cardiac surgeries. However, there is a lack of consensus on the use of amiodarone and other antiarrhythmic drugs as prophylaxis to reduce the occurrence of all types of postoperative arrhythmias in cardiac and non-cardiac surgeries. A comprehensive PubMed query yielded 614 relevant papers, of which 52 clinical trials were analyzed. The data collection included the class of antiarrhythmics, timing or method of drug administration, surgery type, type of arrhythmia and its incidence, and hospitalization length. Statistical analyses focused on prophylactic antiarrhythmics and their respective reductions in postoperative arrhythmias and hospitalization length.Prophylactic amiodarone alone compared to placebo demonstrated a significant reduction in postoperative arrhythmia incidence in cardiac and non-cardiac surgeries (24.01%, p<0.0001), and it was the only treatment group to significantly reduce hospitalization length versus placebo (p = 0.0441). Prophylactic use of class 4 antiarrhythmics versus placebo also demonstrated a significant reduction in postoperative arrhythmia incidence (28.01%, p<0.0001), and while there was no significant statistical reduction compared to amiodarone (4%, p=0.9941), a lack of abundant data provides a case for further research on the prophylactic use of class 4 antiarrhythmics for this indication.Amiodarone prophylaxis remains a prime cornerstone of therapy in reducing postoperative arrhythmia incidence and hospitalization length. Emerging data suggests a need for a broader exploration of alternative antiarrhythmic agents and combination therapies, particularly class 4 antiarrhythmics, in both cardiac and non-cardiac surgeries. This meta-analysis depicts the effectiveness of amiodarone, among other antiarrhythmics, in postoperative arrhythmia incidence and hospitalization length reduction in cardiac and non-cardiac surgeries.

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