A randomized, controlled study of amiodarone for prevention of atrial fibrillation after transthoracic esophagectomy.
OBJECTIVE
Atrial fibrillation is common after esophagectomy. The objective of this study was to determine the efficacy and safety of amiodarone for prevention of atrial fibrillation after transthoracic esophagectomy.


METHODS
Eighty patients undergoing transthoracic esophagectomy were randomly, prospectively assigned to receive amiodarone (n = 40) or no prophylaxis (control group, n = 40). Amiodarone-treated patients received the drug by continuous infusion, initiated at the time of induction of anesthesia, at a rate of 0.73 mg/min (43.75 mg/h), and continued for 96 hours (total dose 4200 mg). The primary end point was atrial fibrillation requiring treatment. Secondary end points included any atrial fibrillation lasting longer than 30 seconds and postoperative hospital and intensive care unit stays.


RESULTS
There were no significant differences between the amiodarone and control groups in demographic characteristics, comorbid conditions, or preoperative or postoperative use of beta-blockers or calcium-channel blockers. The incidence of atrial fibrillation requiring treatment was lower in the amiodarone group than in the control group (15% vs 40%, P = .02, relative risk reduction 62.5%). There were no significant differences between the amiodarone and control groups in median hospital stay (11 days vs 12 days, P = .31) or median intensive care unit stay (68 hours vs 77 hours, p = .097). There were no significant difference between the groups in the incidences of adverse effects.


CONCLUSIONS
Amiodarone prophylaxis significantly reduced the incidence of atrial fibrillation after transthoracic esophagectomy.
Tisdale
James E
JE
Department of Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, Purdue University, Indianapolis, Ind 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
D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives / Q000097:blood; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003422:Critical Care; D004334:Drug Administration Schedule; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007196:Indiana; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; C036116:desethylamiodarone; D000638:Amiodarone