Giving IV and oral amiodarone perioperatively for the prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery: the GAP study.
OBJECTIVE
We studied the use of perioperative IV and oral administration of amiodarone for the prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass graft surgery (CABG).


BACKGROUND
In the United States, > 500,000 patients undergo CABG each year. Numerous studies to date have suggested that postoperative atrial fibrillation occurs in 30 to 50% of patients, leading to significant morbidity, including hypotension, heart failure, thromboembolic complications, prolonged hospital stay, and increased hospital costs. The objective of this study was to assess the use of IV amiodarone in combination with oral amiodarone to reduce the incidence of postoperative atrial fibrillation.


METHODS
From January 1999 to October 1999, 51 patients scheduled for CABG were randomly selected for participation in the amiodarone administration trial. IV amiodarone, 0.73 mg/min, was administered on call to the operating room for 48 h, followed by oral amiodarone, 400 mg q12h, for the next 3 days. The amiodarone group was case-control matched to the incidence of postoperative atrial fibrillation in 92 patients undergoing CABG using conventional medical therapy during the same period. The primary end point of this study was the incidence of postoperative atrial fibrillation, length of hospital stay, and hospital costs, compared to the control group undergoing CABG during the same time.


RESULTS
Atrial fibrillation occurred in 3 of 51 patients (5.88%) in the amiodarone group, compared to 24 of 92 patients (26.08%) in the control group. Length of hospital stay in the amiodarone group was less than in the control group (5.3 days vs 6.7 days), with a trend toward decrease in hospital costs.


CONCLUSIONS
The administration of IV amiodarone in conjunction with oral amiodarone for a total dose of 4,500 mg over 5 days appears to be a hemodynamically well-tolerated, safe, and effective treatment in decreasing the incidence of postoperative atrial fibrillation, shortening length of stay, and a trend toward lowering hospital costs, even in patients with significantly reduced left ventricular function (< 30%). A large multicenter study using IV and oral amiodarone should be pursued prior to deciding whether its use should become standard therapy in all patients undergoing CABG in order to decrease the incidence of postoperative atrial fibrillation.
Kerstein
Joshua
J
Maimonides Medical Center, 953 49th St, Brooklyn, NY 11219, USA.
Soodan
Ajay
A
Qamar
Mehdi
M
Majid
Mazhar
M
Lichstein
Edgar
E
Hollander
Gerald
G
Shani
Jacob
J
D000284:Administration, Oral; D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001281:Atrial Fibrillation / Q000191:economics / Q000517:prevention & control*; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000191:economics; D003324:Coronary Artery Disease / Q000191:economics / Q000601:surgery*; D017046:Cost Savings / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D011292:Premedication / Q000191:economics
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone