JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Anil Apaydin
Hakan Posacioglu
Tanzer Calkavur
Suat Buket
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yagdi, T.
Right arrow Articles by Buket, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yagdi, T.
Right arrow Articles by Buket, S.
Related Collections
Right arrow Cardiac - pharmacology
Right arrow Coronary disease
Right arrow Electrophysiology - arrhythmias
Right arrowRelated Article

J Thorac Cardiovasc Surg 2003;125:1420-1425
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting

Tahir Yagdi, MD, Sanem Nalbantgil, MD, Fatih Ayik, MD, Anil Apaydin, MD, Fatih Islamoglu, MD, Hakan Posacioglu, MD, Tanzer Calkavur, MD, Yuksel Atay, MD, Suat Buket, MD

From the Ege University Medical Faculty, Department of Cardiovascular Surgery, zmir, Turkey.

Received for publication March 29, 2002. Revisions requested July 15, 2002; revisions received Aug 2, 2002. Accepted for publication Aug 15, 2002. Address for reprints: Tahir Yagdi, MD, Ege University Medical Faculty, Department of Cardiovascular Surgery, Bornova, Izmir 35100, Turkey (E-mail: tyagdi{at}med.ege.edu.tr).


   Abstract
Top
 Abstract
Introduction
 Patients and methods
 Results
 Discussion
 References
 
Objective: The purpose of this study was to evaluate the safety and efficacy of postoperative administration of prophylactic amiodarone in the prevention of new-onset postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.
Methods: In this prospective study 157 patients were randomly divided into two groups: 77 patients (amiodarone group) received intravenous amiodarone in a dose of 10 mg/kg/d for postoperative 48 hours. On postoperative day 2 oral amiodarone was started with a dose of 600 mg/d for 5 days, 400 mg/d for the following 5 days, and 200 mg/d for 20 days, and 80 patients received placebo (control group).
Results: Preoperative patient characteristics and operative variables were similar in the two groups. Postoperative atrial fibrillation occurred in 8 patients (10.4%) receiving amiodarone and in 20 (25.0%) patients receiving placebo (P = .017). Duration of atrial fibrillation was 12.8 ± 4.8 hours for the amiodarone group compared with 34.7 ± 28.7 hours for the control group (P = .003). The maximum ventricular rate during atrial fibrillation was slower in the amiodarone group than in the control group (105.9 ± 19.1 beats per minute and 126.0 ± 18.5 beats per minute, respectively, P = .016). The two groups had a similar incidence of complication other than rhythm disturbances (20.8% vs 20.0%, P = .904). Amiodarone group patients had shorter hospital stays than that of control group patients (6.8 ± 1.7 days vs 7.8 ± 2.9 days, P = .014). The in-hospital mortality was not different between two groups (1.3% vs 3.8, P = .620).
Conclusions: Postoperative intravenous amiodarone, followed by oral amiodarone, appears to be effective in the prevention of new-onset postoperative atrial fibrillation. It also reduces ventricular rate and duration of atrial fibrillation after coronary artery bypass grafting. It is well tolerated and decreases the length of hospital stay.


   Introduction
Top
 Abstract
 Introduction
Patients and methods
 Results
 Discussion
 References
 
See related editorial on page 1202.



View larger version (139K):
[in this window]
[in a new window]
  		Dr Yagdi

 
New-onset atrial fibrillation (AF) is a frequent clinical problem and occurs in up to one third of patients undergoing coronary artery bypass grafting (CABG), with a peak incidence on postoperative days 2 to 3.Go Go 1-4 Advanced age and withdrawal of preoperative ß-blockers, together with postoperative sympathetic activation and a history of preoperative paroxysmal supraventricular arrhythmia, seem to play a major role in the development of AF.Go 5 Although postoperative AF usually does not result in long-term sequelae, it often increases length and cost of hospital stay due to hemodynamic compromise or thromboembolic complications.Go 6 The loss of contribution of normal atrial contraction on cardiac performance may result in hemodynamic deterioration during the postoperative period.

Over the years, different regimens have been proposed to prevent postoperative AF. Several pharmacologic agents such as digoxin, ß-blockers, calcium channel blockers, quinidine, magnesium, and sotalol have been used to prevent the occurrence of AF after CABG.Go Go 7-12 Many of these agents have been disappointing and none of them has been uniformly accepted as a drug of choice.

Amiodarone, a class III antiarrhythmic drug with antiadrenergic properties, has been reported to be effective in converting AF to sinus rhythm and in the treatment of refractory AF.Go Go 13,14 Although considered to be a class III antiarrhythmic, amiodarone also has class I, II, and IV actions, which give it a unique pharmacologic and antiarrhythmic profile.Go 15 It can be taken orally after a high-dose preloading.Go 16 Preoperative oral amiodarone has been shown to decrease the occurrence of AF after cardiac surgery.Go 17 In this prospective study, we aimed to assess the efficacy of short-course intravenous amiodarone followed by oral therapy in the prevention of new-onset AF after CABG.


   Patients and methods
Top
 Abstract
 Introduction
 Patients and methods
Results
 Discussion
 References
 
Patient selection
This prospective trial evaluated 157 patients (mean age 60.2 ± 9.3, range 36-78 years) who underwent elective CABG at Ege University Hospital from October 2000 to November 2001. There were 121 men and 36 women. All of the patients were in sinus rhythm and had a baseline corrected QT interval of 440 ms or less. Exclusion criteria were refusal of consent; the presence of preoperative chronic AF; history of paroxysmal AF; myocardial infarction less than 3 weeks before surgery; second- or third-degree atrioventricular block; sick sinus syndrome; need for temporary or permanent pacemaker; preoperative use of certain interacting drugs (phenytoin, cyclosporine, cholestyramine, cimetidine, or class I and class III antiarrhythmic drugs); history of amiodarone side effects; use of amiodarone in the year preceding the operation; heart rate less than 60 beats/min at rest; an initial systolic blood pressure of less than 100 mm Hg; redo coronary artery bypass surgery; concomitant operations such as valve replacement and aneurysmectomy; thyroid disease; asthma; chronic obstructive pulmonary disease; chronic renal failure (serum creatinine greater than 1.9 mg/dL); or liver function test results greater than 2 times normal. The Institutional Review Board approved the study, and all patients gave written informed consent for participation in the study the day before surgery.

Study protocol
The patients were randomly assigned in a double-blind fashion to treatment with amiodarone or placebo. In the amiodarone group, intravenous amiodarone was begun postoperatively, within 2 hours of entering the cardiovascular surgical intensive care unit (ICU). An intravenous infusion without a loading dose was given for 48 hours at a dose of 10 mg/kg per day. On postoperative day 2 the patients started to receive oral amiodarone 600 mg per day three times a day for 5 days, 400 mg per day twice a day for the following 5 day-period, and 200 mg per day in a single dose for the last 20 days for a total of 30 days. For patients randomized to the control arm, a 5% glucose infusion was given intravenously for the first 48 hours. The patients were then switched to oral placebo in the same manner as the amiodarone group. To avoid an increased incidence of AF as a result of ß-blocker withdrawal, ß-blockers were continued in patients who were receiving ß-blockers at the time of the surgery, if possible.

Operative techniques
All operations were performed through a median sternotomy. Cardiopulmonary bypass (CPB) was established via standard aortocaval cannulation with a roller pump and hollow-fiber membrane oxygenator at moderate hypothermia (28°C to 30°C), with pump flow rates of 2.0 to 2.5 L.min-1.m-2 to maintain a perfusion pressure of about 65 mm Hg. During bypass the hematocrit value was maintained between 20% and 25%. After aortic crossclamping, all patients received intermittent cold blood cardioplegia. Cardioplegic solution was delivered either in an antegrade fashion via the aortic root or in a retrograde fashion via the coronary sinus. Topical hypothermia with cold saline solution was used in all operations. Distal anastomoses were performed during a period of aortic crossclamping and proximal anastomoses were performed with partial aortic clamping during rewarming. Conduits for bypass included saphenous veins or internal thoracic arteries or a combination of the two.

Postoperative monitoring
After surgery, all patients were admitted to the cardiovascular surgical ICU and monitored continuously with electrocardiography, three-channel pressure, and cardiac output via pulmonary artery catheter. When the patients were transferred to wards, continuous electrocardiographic tracings were recorded until hospital discharge. Twelve-lead electrocardiograms was done routinely every day and additionally when an arrhythmia was detected during the hospital stay to confirm and document any rhythm disturbances. QTC intervals were measured by the use of the Bazett formula. Postoperative AF was defined as atrial activity that was either not discernible or completely unorganized, accompanied by an irregular ventricular rate lasting more than 5 minutes or requiring therapy as a result of hemodynamic compromise. Management of AF was directed by the cardiac surgery team. We began oral anticoagulation with warfarin when the arrhythmia was persistent for more than 24 hours. At the end of the prophylactic oral amiodarone therapy (postoperative day 30), all patients were clinically examined and a 12-lead electrocardiogram was obtained. Intraoperative and postoperative data, including complications and adverse events, were assessed through a medical record review.

Statistical analysis
Statistical analysis was performed with the Statistical Package for Social Sciences (SPSS Inc, Chicago, Ill). Where appropriate, data are expressed as mean values ± standard deviation or as percentages. Once the homogeneity was confirmed with the Levene test, independent-samples t test was used to compare the noncategorical or continuous variables. Comparison between groups for categorical variables was made by the {chi}2 test and Fisher exact test was used if expected contingency table cell frequencies were less than 5.


   Results
Top
 Abstract
 Introduction
 Patients and methods
 Results
Discussion
 References
 
Baseline characteristics
Of the 157 patients enrolled in this study, 77 were randomized to receive amiodarone, whereas 80 were randomized to receive placebo. The mean age of the patients was 59.3 ± 8.9 years in the amiodarone group and 61.1 ± 9.6 years in the control group (P = .212). The patient demographics and preoperative variables are summarized in Table 1 and were not significantly different. Prevalence of coexisting disorders and coronary risk factors such as hypertension, diabetes mellitus, and hyperlipidemia in both groups of patients was similar (Table 2).


View this table:
[in this window]
[in a new window]
  		Table 1. Patients demographics and preoperative variables (mean ± SD)
 

View this table:
[in this window]
[in a new window]
  		Table 2. Associated coexisting disorders and coronary risk factors
 
Operative variables
Operative variables are summarized in Table 3. There were no significant differences in CPB time, crossclamp time, number of grafts, and intraoperative hemodynamic variables.


View this table:
[in this window]
[in a new window]
  		Table 3. Operative variables (mean ± SD)
 
Postoperative AF
The incidence of new-onset AF occurring during hospitalization was 10.4% (8 patients) in the amiodarone group and 25.0% (20 patients) in the control group (P = .017). AF occurred at a mean of 1.9 ± 0.6 days after surgery in the amiodarone group and 2.5 ± 1.3 days after surgery in the control group (P = .239). The maximum ventricular rate during AF was significantly lower in the amiodarone group than in the control group (105.9 ± 19.1 vs 126.0 ± 18.5 beats/min, P = .016). There was significant difference between the groups in the duration of AF (12.8 ± 4.8 hours vs 34.7 ± 28.7 hours, P = .003). In the amiodarone group, AF converted to sinus rhythm spontaneously in 4 patients. In the remaining patients, 2 treated successfully with ß-blocker, 1 with digoxin, and the last 1 with electrical cardioversion. In the control group, AF converted to sinus rhythm spontaneously in 1 patient. Among the other 19 patients, 7 patients were managed with amiodarone, 5 with digoxin, 2 with calcium-channel blockers, 1 with ß-blocker, and 4 with electrical cardioversion. One patient in the amiodarone group had symptomatic AF within 3 weeks of discharge, whereas 4 patients (5.0%) in the control group had symptomatic AF in the same period (P = .367).

Postoperative complications
Postoperative complications other than rhythm disturbances occurred in 32 patients (16 in the amiodarone group and 16 in the control group, P = .904). Postoperative complications and results are shown in Table 4. There was no significant difference in the incidence of low cardiac output, cerebrovascular accident, respiratory complication, or renal dysfunction. More rhythm disturbances such as ventricular fibrillation or ventricular arrhythmia were detected in the control group (18.8% vs 7.8%, P = .044).


View this table:
[in this window]
[in a new window]
  		Table 4. Postoperative complications and results
 
Amiodarone had to be discontinued in 4 patients (5.2%) because of sinus bradycardia (heart rate less than 60 beats/min) or excessive corrected QT interval prolongation (>440 ms). In these patients bradycardia resolved after discontinuation of amiodarone, and AF did not occur in any of them. In comparison, 2 patients (2.5%) in control group had significant bradycardia (P = .437). Additionally, a higher incidence of postoperative hypotension was observed in patients receiving amiodarone (10.4% vs 5.0%), but this did not reach statistical significance. No patients in the amiodarone group had other significant side effects or adverse reactions included pulmonary toxicity during the study. Nausea was the most frequent side effect in the amiodarone group, which did not require the discontinuation of the amiodarone. ß-Blockers were discontinued in 3 (3.9%) of the amiodarone group patients and in 2 (2.5%) of control group patients (P = .677). In all patients the reason of discontinuation was low cardiac output.

The average length of in-hospital stay for patients in amiodarone group was 6.8 ± 1.7 days, whereas it was 7.8 ± 2.9 days for patients in control group (P = .014). There was one postoperative death (1.3%) in amiodarone group. The cause of death was cerebrovascular accident in a patient who did not have AF. There were 3 postoperative deaths in control group. AF occurred in 2 of them. The causes of deaths in control group patients were ventricular tachyarrhythmia in 2 patients and low cardiac output in 1 patient.


   Discussion
Top
 Abstract
 Introduction
 Patients and methods
 Results
 Discussion
References
 
Despite the advances in surgical technique and myocardial protection, the incidence of AF has not been decreased after cardiac surgery, especially in elderly patients.Go Go 17,18 Advances in continuous monitoring technology have led to more frequent diagnosis of AF. Our results confirm the high incidence of AF in patients who had CABG. AF has been thought of as transient and benign, but it can lead to hemodynamic instability or peripheral embolization. Postoperative AF is a widely known risk factor for postoperative stroke.Go 19

It appears that there are multiple underlying pathophysiologic mechanisms responsible for the high incidence of postoperative AF. Preoperative factors such as an increased age, hypertension, chronic obstructive pulmonary disease, greater number of grafts, poor left ventricular function, preoperative ß-blocker withdrawal, and history of AF were identified as predictors of AF.Go Go Go 5,20,21 Previous studies have indicated that AF after CABG is associated with sympathetic activity.Go 22 Pericardial inflammation or effusion has been detected after cardiac surgery before AF develops.Go 23 The incidence of postoperative atrial arrhythmia was found to be higher in patients with a history of paroxysmal AF.Go 24 A combination of the factors outlined above might be important in the occurrence of AF.

Although long-term sequelae of postoperative AF are unusual, the frequent consequence is prolonged hospitalization and increased medical costs. Therefore, any intervention that would reduce the incidence of postoperative AF would result in an economic benefit. A variety of pharmacologic strategies are available to prevent AF after cardiac surgery. However, controversies still continue about the risks and benefits of these strategies.

The principles of treatment for postoperative AF are the control of the ventricular rate, anticoagulation, and conversion to sinus rhythm. Amiodarone increases the refractory period of atrial and ventricular muscle as well as the atrioventricular node. It has mild ß-blocker and calcium channel blocker activity in addition to its class III antiarrhythmic activity. It has been effective in acute as well as chronic AF.Go 25 As a result of these properties, amiodarone has been studied in the prevention of AF after cardiac operations.Go Go 26-30 Use of oral amiodarone preoperatively and/or postoperatively was investigated in some of these studies.Go Go Go Go 17,25,29,31 Others have used postoperative intravenous amiodarone.Go Go Go 10,32,33 In most of these studies, amiodarone administration ranged from 2 to 15 days. After short-term low-dose intravenous administration, AF tended to occur after termination of the infusion.Go Go 21,33 There is no consensus about the optimal dose of amiodarone. In most of the studies, intravenous amiodarone doses ranged from 10 to 20 mg/kg per day over 2 to 8 days.Go Go Go Go Go Go Go 10,16,21,26,28,32,33 Oral amiodarone doses ranged from 2.8 to 7.0 g over 7 to 20 days.Go Go Go Go Go 17,25,27,29-31 A limited number of trials used a combination of intravenous and oral amiodarone.Go Go 16,28 The variability in dosing strategy and the inconsistency in results have led us to adopt a new regimen. We used a combination of postoperative intravenous amiodarone after oral administration for two reasons: first, to take the advantage of accelerated loading time with the intravenous amiodarone, and second, to obtain the incremental benefits of the oral amiodarone over the short-term intravenous administration. To prevent the possible adverse effects such as hypotension or bradycardia, we have used relatively short-term low-dose (10 mg/kg per day for 48 hours) intravenous administration followed by oral tapered doses at a total of 9.0 g over 30 days. We have used a dosing strategy that gives higher total dose by increasing the length of oral administration instead of giving it at a relatively high dose in a short hospitalization period.

Our study showed that in CABG patients amiodarone in the immediate postoperative period effectively reduced the incidence of postoperative AF by more than 50%. Among the patients who did have AF, amiodarone reduced the ventricular rate significantly. The duration of AF was also longer in control group patients. Postoperative AF is often a transient phenomenon. AF persisted in only 2 patients despite repetitive attempts at restoring sinus rhythm even with electrical cardioversion.

We also investigated the effect of amiodarone prophylaxis on the length of ICU and in-hospital stay. The length of hospitalization was significantly reduced from 7.8 to 6.8 days. This can be explained by increased duration of AF in control group patients. We found that amiodarone prophylaxis is cost-effective even it only reduces the length of stay by 1 day. In our protocol, total cost of amiodarone is only one third that of the cost of 1-day hospitalization.

In the present study, development of AF did not produce significant increases in the length of ICU stay. AF occurred mostly after postoperative day 2, when the patients have already left the ICU. In our practice, new-onset AF without hemodynamic compromise is not an indication for readmission to ICU. In addition to the lower incidence of postoperative AF, the amiodarone group patients had significantly less postoperative ventricular arrhythmias than the control group. Fatal ventricular tachyarrhythmia was not seen in the amiodarone group, whereas 2 deaths in the control group related to ventricular tachyarrhythmia. These results may be due to its effectiveness against a broad range of arrhythmias. Accordingly, large randomized trials indicate that amiodarone is a potent suppressor of ventricular arrhythmia and reduces arrhythmic death after myocardial infarction.Go Go 34,35 Patients whose ß-blocker therapy is discontinued postoperatively have a higher incidence of postoperative atrial tachyarrhythmias.Go 36 In the present study, patients who had been receiving ß-blockers before surgery continued to receive them, if possible, postoperatively. One of the drawbacks of our study is that the number of study patients (approximately 26.0%) who received preoperative ß-blocking drugs is limited. In our hospital, preoperative management was directed by the patients' cardiologist rather than by a standardized protocol. We think that possible negative impact of this nonstandardized treatment have been compensated by the randomization of patients. There is no difference in the percentage of patients who were receiving ß-blockers between the groups in either the preoperative or the postoperative period.

Our homogenous patient population demonstrates the efficacy and safety of a combination of intravenous and oral amiodarone after CABG. The combined intravenous and oral amiodarone regimen used in this study appears to be well tolerated. Amiodarone was discontinued approximately 5% of our patients because of sinus bradycardia and excessive QT prolongation. Additionally, a higher incidence of postoperative hypotension that was observed in patients receiving amiodarone (10.4% vs 5.0%) did not reach to statistical significance. No proarrhythmic effect was observed among the patients who received amiodarone. The direct negative inotropic effect of the drug is minimal and transient, may be partially caused by its antisympathetic effect, and usually does not lead to a decreased cardiac output.Go 37 Amiodarone is well tolerated in patients with poor left ventricular function and can be used for patients who are not candidates for ß-blockade. The group of patients with left ventricular ejection fraction less than 30% represents a small percentage (10%) in our study population. Our primary aim was not to investigate the effect of amiodarone in patients with poor left ventricular function. Our results may not be applicable to the cohort of patients with a lower ejection fraction.

In conclusion, we showed that postoperative intravenous amiodarone followed by oral administration significantly reduced the incidence of new-onset postoperative AF without an increase in adverse effects. It also reduced the ventricular rate and the duration of AF, as well as the length of hospital stay.


   References
Top
 Abstract
 Introduction
 Patients and methods
 Results
 Discussion
 References
 

  1. Lauer MS, Eagle KA, Buckley MJ, DeSanctis RW. Atrial fibrillation following coronary artery bypass surgery. Prog Cardiovasc Dis. 1989;31:367-78.[Medline]
  2. Groves PH, Hall RJ. Atrial tachyarrhythmias after cardiac surgery. Eur Heart J. 1991;12:458-63.[Free Full Text]
  3. Andrews TC, Reimold SC, Berlin JA, Antman AM. Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials. Circulation. 1991;84(Suppl):II-236-44.
  4. Hogue CW Jr, Hyder ML. Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. Ann Thorac Surg. 2000;69:300-6.[Abstract/Free Full Text]
  5. Ducceschi V, D'Andrea A, Liccardo B, et al. Perioperative clinical predictors of atrial fibrillation occurrence following coronary artery bypass surgery. Eur J Cardiothorac Surg. 1999;16:435-9.[Abstract/Free Full Text]
  6. Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg. 1993;56:539-49.[Abstract]
  7. Mills SA, Poole GV Jr, Breyer RH, Holliday RH, et al. Digoxin and propranolol in the prophylaxis of dysrhythmias after coronary artery bypass grafting. Circulation. 1983;68(Suppl):II-222-5.
  8. Williams DB, Misbach GA, Kruse AP, Ivey TD. Oral verapamil for prophylaxis of supraventricular tachycardia after myocardial revascularization: a randomized trial. J Thorac Cardiovasc Surg. 1985;90:592-6.[Abstract]
  9. Yilmaz AT, Demirkilic U, Arslan M, et al. Long-term prevention of atrial fibrillation after coronary artery bypass surgery: comparison of quinidine, verapamil and amiodarone in maintaining sinus rhythm. J Card Surg. 1996;11:61-4.[Medline]
  10. Treggiari-Venzi MM, Waeber JL, Perneger TV, Suter PM, Adamec R, Romand JA. Intravenous amiodarone or magnesium sulfate is not cost-beneficial prophylaxis for atrial fibrillation after coronary artery bypass surgery. Br J Anaesth. 2000;85:690-5.[Abstract/Free Full Text]
  11. Gold MR, O'Gara PT, Buckley MJ, DeSanctis RW. Efficacy and safety of procainamide in preventing arrhythmias after coronary artery bypass surgery. Am J Cardiol. 1996;78:975-9.[Medline]
  12. Nystrom U, Edvardsson N, Berggren H, Pizzarelli GP, Radegran K. Oral sotalol reduces the incidence of atrial fibrillation after coronary artery bypass surgery. Thorac Cardiovasc Surg. 1993;41:34-37.[Medline]
  13. Zarembski DG, Nolan PE, Slack MK, Caruso AC. Treatment of resistant atrial fibrillation: a meta-analysis comparing amiodarone and flecainide. Arch Intern Med. 1995;155:1885-91.[Abstract]
  14. Gosselink AT, Crijns HJ, Van Gelder IC, Hillige H, Wiesfeld AC, Lie KI. Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter. JAMA. 1992;267:3289-93.[Abstract]
  15. Doggrell SA. Amiodarone—waxed and waned and waxed again. Expert Opin Pharmacother. 2001;2:1877-90.[Medline]
  16. Butler J, Harriss DR, Sinclair M, Westaby S. Amiodarone prophylaxis for tachycardia after coronary artery bypass surgery: a randomized double-blind placebo controlled trial. Br Heart J. 1993;70:56-60.[Abstract/Free Full Text]
  17. Daoud EG, Strickberger SA, Man KC, et al. Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med. 1997;337:1785-91.[Abstract/Free Full Text]
  18. Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med. 1997;336:1429-34.[Free Full Text]
  19. Reed GL III, Singer DE, Picard EH, DeSanctis RW. Stroke following coronary-artery bypass surgery. N Engl J Med. 1988;319:1246-50.[Abstract]
  20. Mathew JP, Parks R, Savino JS, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. Multicenter Study of Perioperative Ischemia Research Group. JAMA. 1996;276:300-6.[Abstract]
  21. Dorge H, Schoendube FA, Schoberer M, Stellbrink C, Voss M, Messmer BJ. Intraoperative amiodarone as prophylaxis against atrial fibrillation after coronary operations. Ann Thorac Surg. 2000;69:1358-62.[Abstract/Free Full Text]
  22. Kalman JM, Munawar M, Howes LG, et al. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg. 1995;60:1709-15.[Abstract/Free Full Text]
  23. Chidambaram M, Akhtar MJ, al-Nozha M, al-Saddique A. Relationship of atrial fibrillation to significant pericardial effusion in valve-replacement patients. Thorac Cardiovasc Surg. 1992;40:70-3.[Medline]
  24. Hashimoto K, Ilstrup DM, Schaff HV. Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after coronary artery bypass. J Thorac Cardiovasc Surg. 1991;101:56-65.[Abstract]
  25. Katariya K, DeMarchena E, Bolooki H. Oral amiodarone reduces incidence of postoperative atrial fibrillation. Ann Thorac Surg. 1999;68:1599-604.[Abstract/Free Full Text]
  26. Lee SH, Chang CM, Lu MJ, et al. Intravenous amiodarone for prevention of atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg. 2000;70:157-61.[Abstract/Free Full Text]
  27. Giri S, White CM, Dunn AB, et al. Oral amiodarone for prevention of atrial fibrillation after open heart surgery, the Atrial Fibrillation Suppression Trial (AFIST): a randomized placebo-controlled trial. Lancet. 2001;357:830-6.[Medline]
  28. Solomon AJ, Greenberg MD, Kilborn MJ, Katz NM. Amiodarone versus a ß-blocker to prevent atrial fibrillation after cardiovascular surgery. Am Heart J. 2001;142:811-5.[Medline]
  29. Maras D, Boskovic SD, Popovic Z, et al. Single-day loading dose of oral amiodarone for the prevention of new-onset atrial fibrillation after coronary artery bypass surgery. Am Heart J. 2001;141:E8.[Medline]
  30. Redle JD, Khurana S, Marzan R, et al. Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass surgery. Am Heart J. 1999;138:144-50.[Medline]
  31. White CM, Giri S, Tsikouris JP, et al. A comparison of two individual amiodarone regimens to placebo in open heart surgery patients. Ann Thorac Surg. 2002;74:69-74.[Abstract/Free Full Text]
  32. Hohnloser SH, Meinertz T, Dammbacher T, et al. Electrocardiographic and antiarrhythmic effects of intravenous amiodarone. Am Heart J. 1991;121:89-95.[Medline]
  33. Guarnieri T, Nolan S, Gottlieb SO, Dudek A, Lowry DR. Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the Amiodarone Reduction in Coronary Heart (ARCH) trial. J Am Coll Cardiol. 1999;34:343-7.[Abstract/Free Full Text]
  34. Cairns JA, Connolly SJ, Roberts R, Gent M. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial (CAMIAT): rationale and protocol. CAMIAT Investigators. Am J Cardiol. 1993;72:87F-94F.[Medline]
  35. Camm AJ, Julian D, Janse G, et al. The European Myocardial Infarct Amiodarone Trial (EMIAT). EMIAT Investigators. Am J Cardiol. 1993;72:95F-98F.[Medline]
  36. Abel RM, van Gelder HM, Pores IH, Liguori J, Gielchinsky I, Parsonnet V. Continued propranolol administration following coronary bypass surgery: antiarrhythmic effects. Arch Surg. 1983;118:727-31.[Abstract]
  37. Kowey PR, Marinchak RA, Rials SJ, Filart RA. Intravenous amiodarone. J Am Coll Cardiol. 1997;29:1190-8.[Abstract]

Related Article

Is it time to choose amiodarone for postoperative atrial fibrillation?
Adam E. Saltman
J. Thorac. Cardiovasc. Surg. 2003 125: 1202-1203. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
L. R. Zebis, T. D. Christensen, I. S. Kristiansen, and V. E. Hjortdal
Amiodarone Cost Effectiveness in Preventing Atrial Fibrillation After Coronary Artery Bypass Graft Surgery
Ann. Thorac. Surg., January 1, 2008; 85(1): 28 - 32.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
F. Roshanali, M. H. Mandegar, M. A. Yousefnia, H. Rayatzadeh, F. Alaeddini, and F. Amouzadeh
Prediction of Atrial Fibrillation via Atrial Electromechanical Interval After Coronary Artery Bypass Grafting
Circulation, October 30, 2007; 116(18): 2012 - 2017.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. R. Zebis, T. D. Christensen, H. F. Thomsen, M. M. Mikkelsen, L. Folkersen, H. T. Sorensen, and V. E. Hjortdal
Practical Regimen for Amiodarone Use in Preventing Postoperative Atrial Fibrillation
Ann. Thorac. Surg., April 1, 2007; 83(4): 1326 - 1331.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
D. C. Burgess, M. J. Kilborn, and A. C. Keech
Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis
Eur. Heart J., December 1, 2006; 27(23): 2846 - 2857.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. M. Bagshaw, P. D. Galbraith, L. B. Mitchell, R. Sauve, D. V. Exner, and W. A. Ghali
Prophylactic Amiodarone for Prevention of Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis
Ann. Thorac. Surg., November 1, 2006; 82(5): 1927 - 1937.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
B. J. Barnes, E. A. Kirkland, P. A. Howard, D. W. Grauer, M. E. Gorton, J. B. Kramer, G. F. Muehlebach, and W. A. Reed
Risk-stratified evaluation of amiodarone to prevent atrial fibrillation after cardiac surgery.
Ann. Thorac. Surg., October 1, 2006; 82(4): 1332 - 1337.
[Abstract] [Full Text] [PDF]

Home page
 Am J Health Syst PharmHome page
A. A. Patel, C. M. White, E. L. Gillespie, J. Kluger, and C. I. Coleman
Safety of amiodarone in the prevention of postoperative atrial fibrillation: A meta-analysis
Am. J. Health Syst. Pharm., May 1, 2006; 63(9): 829 - 837.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
J. Dunning and P. McKeown
Are the american college of chest physicians guidelines for the prevention and management of atrial fibrillation after cardiac surgery already obsolete?
Chest, April 1, 2006; 129(4): 1112 - 1113.
[Full Text] [PDF]

Home page
 Crit Care NurseHome page
L. Brantman and J. Howie
Use of Amiodarone to Prevent Atrial Fibrillation After Cardiac Surgery
Crit. Care Nurse, February 1, 2006; 26(1): 48 - 58.
[Full Text] [PDF]

Home page
 JAMAHome page
L. B. Mitchell, D. V. Exner, D. G. Wyse, C. J. Connolly, G. D. Prystai, A. J. Bayes, W. T. Kidd, T. Kieser, J. J. Burgess, A. Ferland, et al.
Prophylactic Oral Amiodarone for the Prevention of Arrhythmias That Begin Early After Revascularization, Valve Replacement, or Repair: PAPABEAR: A Randomized Controlled Trial
JAMA, December 28, 2005; 294(24): 3093 - 3100.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
J. D. Aasbo, A. T. Lawrence, K. Krishnan, M. H. Kim, and R. G. Trohman
Amiodarone Prophylaxis Reduces Major Cardiovascular Morbidity and Length of Stay after Cardiac Surgery: A Meta-Analysis
Ann Intern Med, September 6, 2005; 143(5): 327 - 336.
[Abstract] [Full Text] [PDF]

Home page
 The Annals of PharmacotherapyHome page
E. L Gillespie, C. I Coleman, S. Sander, J. Kluger, K. A Gryskiewicz, and C M. White
Effect of Prophylactic Amiodarone on Clinical and Economic Outcomes After Cardiothoracic Surgery: A Meta-Analysis
Ann. Pharmacother., September 1, 2005; 39(9): 1409 - 1415.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
P. S. Myles and D. McIlroy
Fast-Track Cardiac Anesthesia: Choice of Anesthetic Agents and Techniques
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 5 - 16.
[Abstract] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
R. Kailasam, C. A. Palin, and C. W. Hogue Jr
Atrial Fibrillation After Cardiac Surgery: An Evidence-Based Approach to Prevention
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 77 - 85.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. DiDomenico and M. G. Massad
Pharmacologic Strategies for Prevention of Atrial Fibrillation After Open Heart Surgery
Ann. Thorac. Surg., February 1, 2005; 79(2): 728 - 740.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
U. Izhar, N. Ad, E. Rudis, E. Milgalter, A. Korach, N. Viola, E. Levi, G. Asraff, G. Merin, and A. Elami
When should we discontinue antiarrhythmic therapy for atrial fibrillation after coronary artery bypass grafting? A prospective randomized study
J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 401 - 406.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. E. Samuels, E. C. Holmes, and F. L. Samuels
Selective Use of Amiodarone and Early Cardioversion for Postoperative Atrial Fibrillation
Ann. Thorac. Surg., January 1, 2005; 79(1): 113 - 116.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
J. Dunning, P. Botha, and M. Amanullah
Prophylactic Amiodarone effectively prevents post-operative atrial fibrillation
Interactive CardioVascular and Thoracic Surgery, September 1, 2004; 3(3): 510 - 515.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. Yazigi, F. Haddad, S. Madi-Jebara, G. Sleilaty, and V. A. Jebara
Amiodarone for postoperative atrial fibrillation
J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 304 - 304.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Anil Apaydin
Hakan Posacioglu
Tanzer Calkavur
Suat Buket
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yagdi, T.
Right arrow Articles by Buket, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yagdi, T.
Right arrow Articles by Buket, S.