Propafenone versus ibutilide for post operative atrial fibrillation following cardiac surgery: neither strategy improves outcomes compared to rate control alone (the PIPAF study).
BACKGROUND
It is unclear whether acute conversion of atrial fibrillation (AF) with anti-arrhythmic drugs following cardiac surgery restores and/or maintains sinus rhythm or reduces hospital length of stay (LOS).


METHODS
A randomized prospective pilot study was conducted in 2 teaching hospitals from 3/28/98 to 8/2/99 to study the effect of the early use of ibutilide or propafenone on the duration of AF, rhythm at discharge, and LOS. A total of 42 stable patients with new AF after surgery were randomized to oral propafenone (600mg, single dose; n=20), ibutilide (1 mg up to 2 doses if necessary; n=10), or rate control only (n=12). Agents used for rate control were left to the discretion of the primary physician but beta-blockers were encouraged.


RESULTS
Pre-randomization distribution of diabetes, CHF, previous AF, and the use of beta-blockers were similar in all groups. At 24 hours 0%, 65% and 34% of patients in the ibutilide (p=0.01), propafenone (p=ns), and rate control groups respectively remained in AF. Although ibutilide decreased AF duration, recurrence rates were 90%, 41%, and 58% in those groups (p=ns compared to rate control). Of the 3 patients who did not convert, all received propafenone. There was no difference in LOS or rhythm at discharge.


CONCLUSIONS
Ibutilide but not propafenone decreases the duration of AF after cardiac surgery and neither appears to affect LOS or rhythm at discharge. This data suggests that post operative AF is transient and routine anti-arrhythmic therapy is not necessary for the majority of patients.
Soucier
Richard
R
The Hoffman Heart Institute of Connecticut, Saint Francis Hospital and Medical Center, Hartford CT 06105, USA. rsoucier@stfranciscare.org
Silverman
David
D
Abordo
Melecio
M
Jaagosild
Priit
P
Abiose
Ademola
A
Madhusoodanan
K P
KP
Therrien
Michael
M
Lippman
Neal
N
Dalamagas
Honora
H
Berns
Ellison
E
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology*; D011405:Propafenone / Q000627:therapeutic use*; D011446:Prospective Studies; D013449:Sulfonamides / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide; D011405:Propafenone