title: Amiodarone prophylaxis for atrial fibrillation of high-risk patients after coronary bypass grafting: a prospective, double-blinded, placebo-controlled, randomized study.
abstract: OBJECTIVE
  Atrial fibrillation (AF) occurs often in patients after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality. Previous studies using P-wave signal-averaged electrocardiogram (P-SAECG) have shown that patients with a longer filtered P-wave duration (FPD) have a high risk of AF after CABG. We have shown that patients with an FPD > or = 124 ms and a root-mean-square voltage of the last 20 ms of the P-wave 20 < or = 3.7 microV have an increased risk of AF after surgery. Accordingly, the aim of this study was to investigate whether or not prophylactic peri-operative administration of amiodarone could reduce the incidence of AF in this high-risk group undergoing CABG identified by P-SAECG.
  
  
  RESULTS
  In this prospective, double-blinded, placebo-controlled, randomized study, 110 patients received either amiodarone (n = 55) or placebo (n = 55). During CABG, two patients of both groups died. Amiodarone was given as 600 mg oral single dose one day before and from days 2 through 7 after surgery. In addition, amiodarone was also administered intravenously during surgery in a 300-mg bolus for 1 h and as a total maintenance dose of 20 mg/kg weight over 24 h on the first day following surgery. The primary endpoint was the occurrence of AF after CABG. The secondary endpoint was the hospitalization length of stay after CABG. The baseline characteristics were similar in both treatment groups. The incidence of post-operative AF was significantly higher in the placebo group compared with the amiodarone group (85 vs. 34% of patients, P < 0.0001). The prophylactic therapy with amiodarone significantly reduced the intensive care (1.8 +/- 1.7 vs. 2.4 +/- 1.5 days, P = 0.001) and hospitalization length of stay (11.3 +/- 3.4 vs. 13.0 +/- 4.3 days, P = 0.03). In the amiodarone group, concentrations of amiodarone and desethylamiodarone differed significantly between patients with AF and sinus rhythm (amiodarone: 0.96 +/- 0.5 vs. 0.62 +/- 0.4 microg/mL, P = 0.02; desethylamiodarone: 0.65 +/- 0.2 vs. 0.48 +/- 0.1 microg/mL, P = 0.04).
  
  
  CONCLUSIONS
  The incidence of post-operative AF among high-risk patients was significantly reduced by a prophylactic amiodarone treatment resulting in a shorter time of intensive care unit and hospital stay. Our data supports the prophylactic use of amiodarone in peri-operative period in patients at high risk for AF after CABG.
authors.affiliation: Department of Cardiology, West-German Heart Centre, University of Duisburg-Essen Hufelandstr, 55 D-45122 Essen, Germany. marco.budeus@medizin.uni-essen.de
authors.forename: Marco
authors.initials: M
authors.lastname: Budeus
authors.forename: Marcus
authors.initials: M
authors.lastname: Hennersdorf
authors.forename: Stefan
authors.initials: S
authors.lastname: Perings
authors.forename: Shinga
authors.initials: S
authors.lastname: Röhlen
authors.forename: Stefan
authors.initials: S
authors.lastname: Schnitzler
authors.forename: Oliver
authors.initials: O
authors.lastname: Felix
authors.forename: Klaus
authors.initials: K
authors.lastname: Reimert
authors.forename: Peter
authors.initials: P
authors.lastname: Feindt
authors.forename: Emmeran
authors.initials: E
authors.lastname: Gams
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.forename: Heinrich
authors.initials: H
authors.lastname: Wieneke
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Christian
authors.initials: C
authors.lastname: Perings
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D001026:Coronary Artery Bypass; D003422:Critical Care; D018572:Disease-Free Survival; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone