Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery.
OBJECTIVE
We sought to determine whether early prophylaxis with an L -type calcium channel blocker reduces the incidence and morbidity associated with atrial fibrillation/flutter and supraventricular tachyarrhythmia after major thoracic operations.


METHODS
In this randomized, double-blind, placebo-controlled study, 330 patients were given either intravenous diltiazem (n = 167) or placebo (n = 163) immediately after lobectomy (> or =60 years) or pneumonectomy (> or =18 years) and orally thereafter for 14 days. The primary end point with respect to efficacy was a sustained (> or =15 minutes) or clinically significant atrial arrhythmia during treatment.


RESULTS
Postoperative atrial arrhythmias (atrial fibrillation/flutter = 60; supraventricular tachyarrhythmias = 5) occurred in 25 (15%) of the 167 patients in the diltiazem group and 40 (25%) of the 163 patients in the placebo group (P = .03). When compared with placebo, diltiazem nearly halved the incidence of clinically significant arrhythmias (17/167 [10%] vs. 31/163 [19%], P = .02). The 2 groups did not differ in the incidence of other major postoperative complications or overall duration or costs of hospitalization. No serious adverse effects caused by diltiazem were seen.


CONCLUSIONS
After major thoracic operations, prophylactic diltiazem reduced the incidence of clinically significant atrial arrhythmias in patients considered at high risk for this complication.
Amar
D
D
Departments of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. amard@mskcc.org
Roistacher
N
N
Rusch
V W
VW
Leung
D H
DH
Ginsburg
I
I
Zhang
H
H
Bains
M S
MS
Downey
R J
RJ
Korst
R J
RJ
Ginsberg
R J
RJ
D000284:Administration, Oral; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control*; D001282:Atrial Flutter / Q000453:epidemiology / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004110:Diltiazem / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D013510:Pulmonary Surgical Procedures; D013617:Tachycardia, Supraventricular / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D004110:Diltiazem