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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 911-918, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
HF McAlister, RA Luke, RM Whitlock and WM Smith
The safety and efficacy of amiodarone and quinidine in reverting atrial
tachyarrhythmias after cardiac operations were compared in a randomized
cross-over trial. Patients with sustained atrial fibrillation or flutter
for more than 2 hours' duration, stable hemodynamic status, and prior
digoxin therapy were randomized to receive either intravenous amiodarone, 5
mg/kg over 20 minutes (41 patients), or oral quinidine, 400 mg immediately
and 400 mg in 4 hours (39 patients), with cross-over at 8 hours if
reversion was not achieved. Thirty-six patients had a coronary artery
operation, 35 a valvular operation, five had both, and there were four
miscellaneous cases. There was a male:female ratio of 1.5:1 and a mean age
of 58 years (range 23 to 75 years). Preoperative atrial fibrillation or
flutter was present in nine patients, and four patients had an ejection
fraction less than 40%. Twenty-five of 39 patients (64%) given quinidine
first reverted to sinus rhythm, compared with 17 of 41 patients (41%) given
amiodarone first (2p = 0.04). Side- effects occurred in 18 patients given
quinidine and five patients given amiodarone (2p = 0.01). Two patients,
both given quinidine, were withdrawn from the study. There was no
correlation, with either drug, between serum levels and clinical efficacy.
Multivariate analysis identified longer times from arrhythmia to treatment,
preoperative atrial fibrillation, mitral valve operations, and concomitant
propranolol therapy as factors predictive of failure to revert to sinus
rhythm. Oral quinidine was more effective than intravenous amiodarone in
reverting postoperative atrial fibrillation and flutter but caused more
side-effects.
ARTICLES
Intravenous amiodarone bolus versus oral quinidine for atrial flutter and fibrillation after cardiac operations
Department of Cardiology, Green Lane Hospital, Auckland, New Zealand.
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