Postoperative atrial fibrillation prophylaxis using a novel amiodarone order set

Area of Science:

• Cardiology
• Thoracic Surgery
• Pharmacology

Background:

• Post-operative atrial fibrillation (POAF) is a common complication after lung resection.
• Chemoprophylaxis has shown promise in reducing POAF after anatomic lung resection.
• The necessity of prophylaxis for non-anatomic wedge resections remains unclear due to variable reported rates.

Purpose of the Study:

• To evaluate the institutional rate of POAF following anatomic lung resections.
• To assess the effectiveness of a novel amiodarone administration regimen in preventing POAF after anatomic resection.
• To compare POAF incidence in anatomic resections with the novel regimen versus wedge resections without prophylaxis.

Main Methods:

• Retrospective cohort study of a prospectively maintained database (1/2015-4/2018).
• Comparison of patients undergoing anatomic versus wedge lung resections.
• Implementation of a novel amiodarone order set (300 mg IV bolus followed by 400 mg tablets TID x 3 days) for anatomic resection patients aged ≥65 meeting criteria.

Main Results:

• A total of 537 patients were included (56% anatomic, 44% wedge resection).
• Overall POAF incidence was 5.4%.
• POAF significantly decreased in anatomic resections with the novel regimen compared to historic rates (9.3% vs. 20.3%, P<0.001). Only one wedge resection patient (0.4%) developed POAF. Age ≥65 was the sole independent risk factor for POAF (OR: 5.41).

Conclusions:

• The novel amiodarone order set effectively reduces POAF incidence after anatomic lung resection.
• POAF is infrequent following wedge resections, suggesting chemoprophylaxis is not warranted for this procedure.
• Age remains a significant risk factor for developing POAF post-lung resection.