Amiodarone prophylaxis for atrial fibrillation of high-risk patients after coronary bypass grafting: a prospective,...

Area of Science:

• Cardiology
• Cardiac Surgery
• Pharmacology

Background:

• Atrial fibrillation (AF) is a common complication post-coronary artery bypass grafting (CABG), increasing morbidity and mortality.
• P-wave signal-averaged electrocardiogram (P-SAECG) identifies high-risk patients for post-CABG AF, particularly those with prolonged filtered P-wave duration (FPD).
• Specific P-SAECG criteria (FPD ≥ 124 ms and P-wave root-mean-square voltage < 3.7 µV) indicate elevated AF risk post-surgery.

Purpose of the Study:

• To evaluate the efficacy of prophylactic peri-operative amiodarone in preventing AF in high-risk patients undergoing CABG.
• To assess the impact of amiodarone on reducing AF incidence in this specific patient cohort identified by P-SAECG.
• To determine if amiodarone therapy influences length of hospital stay post-CABG.

Main Methods:

• A prospective, double-blinded, placebo-controlled, randomized study involving 110 patients undergoing CABG.
• Patients received either amiodarone (n=55) or placebo (n=55) with a defined peri-operative dosing regimen.
• Primary endpoint: occurrence of post-operative AF. Secondary endpoint: length of hospital stay. P-SAECG identified high-risk patients.

Main Results:

• The incidence of post-operative AF was significantly lower in the amiodarone group (34%) compared to the placebo group (85%) (P < 0.0001).
• Prophylactic amiodarone significantly reduced intensive care unit (ICU) stay (1.8 vs. 2.4 days, P = 0.001) and overall hospitalization (11.3 vs. 13.0 days, P = 0.03).
• Higher amiodarone and desethylamiodarone concentrations were observed in amiodarone recipients with sinus rhythm compared to those with AF.

Conclusions:

• Prophylactic amiodarone administration effectively reduces the incidence of post-operative AF in high-risk CABG patients.
• Amiodarone therapy leads to a shorter ICU and hospital stay for these patients.
• The findings support the routine prophylactic use of amiodarone during the peri-operative period for high-risk individuals undergoing CABG.