A randomized trial evaluating amiodarone for prevention of atrial fibrillation after pulmonary resection.
BACKGROUND
Atrial fibrillation (AF) occurs commonly after anatomic pulmonary resection. In this study, the efficacy of amiodarone for prevention of post-pulmonary resection AF was investigated.


METHODS
One hundred thirty patients undergoing lobectomy, bilobectomy, or pneumonectomy were randomly assigned prospectively to receive amiodarone (n = 65) or no prophylaxis (control group, n = 65). The amiodarone group received 1,050 mg by continuous intravenous infusion over 24 hours, initiated at the time of anesthesia induction, followed by 400 mg orally twice daily until hospital discharge or for a maximum of 6 days. The primary endpoint was AF requiring treatment during hospitalization. Secondary endpoints included postoperative length of hospital and intensive care unit stays.


RESULTS
There were no significant differences between the amiodarone and control groups in demographics, comorbid conditions, extent of pulmonary resection, or preoperative or postoperative use of beta-blockers or calcium-channel blockers. The incidence of AF was lower in the amiodarone group than in the control group (13.8% versus 32.3%, p = 0.02; relative risk reduction = 57%). There was no difference between the amiodarone and control groups in median length of hospital stay (7 versus 8 days, p = 0.79), but median length of intensive care unit stay was shorter in the amiodarone group (46 versus 84 hours, p = 0.03). There was no significant difference between the amiodarone and control groups in the incidence of pulmonary complications or other adverse effects.


CONCLUSIONS
Amiodarone prophylaxis significantly reduces the incidence of AF after anatomic pulmonary resection, and is associated with a significant reduction in length of intensive care unit stay.
Tisdale
James E
JE
Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Purdue University, Indianapolis, Indiana 46202, USA. jtisdale@iupui.edu
Wroblewski
Heather A
HA
Wall
Donna S
DS
Rieger
Karen M
KM
Hammoud
Zane T
ZT
Young
Jerry V
JV
Kesler
Kenneth A
KA
D000284:Administration, Oral; D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage* / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000517:prevention & control*; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone