Long-term amiodarone therapy and the risk of complications after cardiac surgery: results from the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial (CAMIAT).
OBJECTIVE
This study was undertaken to determine the association between amiodarone therapy and risk of complications of cardiac surgery in patients in the randomized placebo-controlled, double-blind Canadian Amiodarone Myocardial Infarction Arrhythmia Trial.


METHODS
Prospectively collected data regarding postoperative complications in 82 patients who underwent cardiac surgery during Canadian Amiodarone Myocardial Infarction Arrhythmia Trial participation were analyzed; 36 patients were randomly assigned to receive amiodarone and 46 were assigned to receive placebo. Of the patients randomly assigned to receive amiodarone, 24 patients continued amiodarone treatment to within 7 days of the operation (active amiodarone group) and 12 patients had the amiodarone discontinued at least 7 days before the operation (discontinued amiodarone group).


RESULTS
The baseline characteristics of the three groups were similar. The risks of ventricular fibrillation, atrial fibrillation, and respiratory complications were similar. The risk of requiring an intra-aortic balloon pump was significantly increased by amiodarone (34.8% vs 16.7% vs 8.7% for active amiodarone, discontinued amiodarone, and placebo groups, respectively, P =.024). There was no significant difference in the use of temporary pacing. Neither the mean duration of stay in the intensive care unit nor the 7- and 30-days mortalities were affected by amiodarone.


CONCLUSIONS
Patients receiving long-term amiodarone treatment after myocardial infarction had a higher rate of intra-aortic balloon use after cardiac surgery. There was no increased risk of pulmonary complications, need for pacing, or death.
Crystal
Eugene
E
Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. crystal@bgumail.bgu.ac.il
Kahn
Shoshanah
S
Roberts
Robin
R
Thorpe
Kevin
K
Gent
Michael
M
Cairns
John A
JA
Dorian
Paul
P
Connolly
Stuart J
SJ
D000284:Administration, Oral; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D002170:Canada / Q000453:epidemiology; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000379:methods; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000601:surgery*; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone