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J Thorac Cardiovasc Surg 2000;120:790-798
© 2000 The American Association for Thoracic Surgery

General Thoracic Surgery

Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery

David Amar, MDa, , Nancy Roistacher, MDc, , Valerie W. Rusch, MDd, , Denis H. Y. Leung, PhDb, , Ilana Ginsburg, RNa, , Hao Zhang, MDa, , Manjit S. Bains, MDd, , Robert J. Downey, MDd, , Robert J. Korst, MDd, , Robert J. Ginsberg, MDd,

From the Departments of Anesthesiology and Critical Care Medicine,a Epidemiology and Biostatistics,b Medicine,c and Surgery,d Memorial Sloan-Kettering Cancer Center, New York, NY.

Supported in part by a grant from the International Anesthesia Research Society.

Address for reprints: David Amar, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, M-304, New York, NY 10021 (E-mail: amard{at}mskcc.org).

Objectives: We sought to determine whether early prophylaxis with an L-type calcium channel blocker reduces the incidence and morbidity associated with atrial fibrillation/flutter and supraventricular tachyarrhythmia after major thoracic operations.
Methods: In this randomized, double-blind, placebo-controlled study, 330 patients were given either intravenous diltiazem (n = 167) or placebo (n = 163) immediately after lobectomy (>=60 years) or pneumonectomy (>=18 years) and orally thereafter for 14 days. The primary end point with respect to efficacy was a sustained (>=15 minutes) or clinically significant atrial arrhythmia during treatment.
Results: Postoperative atrial arrhythmias (atrial fibrillation/flutter = 60; supraventricular tachyarrhythmias = 5) occurred in 25 (15%) of the 167 patients in the diltiazem group and 40 (25%) of the 163 patients in the placebo group (P = .03). When compared with placebo, diltiazem nearly halved the incidence of clinically significant arrhythmias (17/167 [10%] vs 31/163 [19%], P = .02). The 2 groups did not differ in the incidence of other major postoperative complications or overall duration or costs of hospitalization. No serious adverse effects caused by diltiazem were seen.
Conclusions: After major thoracic operations, prophylactic diltiazem reduced the incidence of clinically significant atrial arrhythmias in patients considered at high risk for this complication.




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