Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting.
OBJECTIVE
This study was designed to assess the effects of a perioperative dosing regimen of amiodarone administration, high thoracic epidural anesthesia (TEA), or a combination of the 2 regimens on atrial fibrillation (AF) after coronary artery bypass grafting (CABG).


METHODS
The study was prospective, controlled, and randomized and was performed in a tertiary health care center associated with a university.


METHODS
One hundred sixty-three patients scheduled for coronary artery bypass graft surgery.


METHODS
In this 2 x 2 factorial-designed study the patients were randomized to 1 of 4 regimens in which group E had perioperative TEA, group E+A had TEA and amiodarone, group A had amiodarone, and group C served as control. The epidural catheter was inserted at T1-3 the day before surgery. TEA groups received TEA for 96 hours. The amiodarone regimen consisted of a single loading dose of 1,800 mg of amiodarone orally. Intravenous infusion of amiodarone was started after induction of anesthesia and was administered at 900 mg over 24 hours for the subsequent 3 days.


RESULTS
AF was documented using Holter monitoring. In group E 22 of 44 (50%), in group E+A 10 of 35 (28.6%), in group A 10 of 36 (27.8%), and in the control group 20 of 48 (41.7%) patients developed AF (odds ratio amiodarone/nonamiodarone 0.47 [0.24-0.90]; P = 0.02).


CONCLUSIONS
The perioperative amiodarone regimen used in this study was effective in reducing the incidence of AF after CABG while TEA was not.
Nygård
Eigil
E
Department of Cardiothoracic Anesthesia, National University Hospital, Rigshopitalet, Copenhagen, Denmark. einy@gentoftehosp.kbhamt.dk
Sørensen
Lars H
LH
Hviid
Lamia B
LB
Pedersen
Finn M
FM
Ravn
Jesper
J
Thomassen
Lars
L
Svendsen
Jesper H
JH
Eliasen
Kirsten
K
Krogsgaard
Kim
K
Aldershvile
Jan
J
D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000627:therapeutic use*; D015360:Analgesia, Epidural / Q000379:methods*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone