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Feasible, practical and economical evaluation of postoperative prophylaxis with amiodarone for the prevention of atrial fibrillation.

Lars Riber Zebis

Summary

Atrial fibrillation is a well-known complication after coronary artery bypass grafting. It occurs with a reported risk varying from 5% to 65%. Former studies have shown the effectiveness of amiodarone in reduction of atrial fibrillation. But they have not been able to establish a safe, practical, and feasible prophylactic regimen to lower the risk of atrial fibrillation after coronary artery bypass grafting. These considerations were the reasons for the initiation of the randomized, controlled, double-blinded trial: "Atrial fibrillation Study in patients undergoing Coronary Artery Bypass Grafting" performed at the Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Skejby from January 19, 2004 to August 31, 2005.

This study showed that the five-day oral treatment with amiodarone after an initial intravenous loading dose at the first postoperative day was a safe, practical, feasible and effective prophylactic regimen to reduce the risk of postoperative atrial fibrillation. 

The study's main results were:

  1. Prophylactic amiodarone significantly diminishes the occurrence of postoperative atrial fibrillation.
  2. Prophylactic amiodarone was as efficient as earlier prophylactic regimens.
  3. It was a feasible treatment, which is easy to incorporate.
  4. Length of stay at the surgical department was not reduced for patients receiving amiodarone prophylaxis.
  5. Overall length of stay was not reduced significantly for patients receiving amiodarone prophylaxis.
  6. Patients free of atrial fibrillation experience a shorter length of stay and therefore contribute to lower in-hospital cost.
  7. Diabetics and non-diabetics have the same benefit of the instituted prophylactic regimen.
  8. Diabetic patients did not differ from non-diabetics with respect to risk of atrial fibrillation, but were hospitalized for a longer periods regardless of receipt of the prophylactic treatment.