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J Thorac Cardiovasc Surg 2004;127:304
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Amiodarone for postoperative atrial fibrillation

Alexander Yazigi, MD, Fadia Haddad, MD, Samia Madi-Jebara, MD

Department of Anesthesiology and Critical Care, Hôtel-Dieu de France, Beirut, Lebanon

Ghassan Sleilaty, MD, Victor A. Jebara, MD

Department of Cardiovascular and Thoracic Surgery, Hôtel-Dieu de France, Beirut, Lebanon

To the Editor:

We read with interest the article by Yagdi and colleagues1 dealing with the use of amiodarone to prevent of postoperative atrial fibrillation (AF). In this prospective, randomized study, 77 patients (amiodarone group) received intravenous amiodarone during the first 48 hours after the operation followed by declining oral dosing over a 30-day period, and 80 patients (control group) received placebo. The authors observed a statistically significant reduction in the incidence of AF (10% in amiodarone group vs 25% in control group) as well as a significant reduction in the mean duration of AF (12.8 ± 4.8 hours in amiodarone group vs 34.7 ± 28.7 hours in control group).

We recently reported similar results in a prospective, randomized study conducted with 200 consecutive patients undergoing CABG.2 The treatment group received oral amiodarone 4 hours after arrival to the intensive care unit and until hospital discharge. The incidence of AF was reduced from 25% to 12%, and its duration was also reduced.

These two prospective randomized trials constitute additional evidence for the efficacy of amiodarone in the prevention of AF after CABG. Interestingly, although in our series only the oral form of amiodarone was used, the results observed were almost identical to those reported by Yagdi and colleagues,1 suggesting that the intravenous administration of amiodarone may not offer additional beneficial effects in preventing postoperative AF. If these observations were to be confirmed in future studies, the problem of the cost-effectiveness of the use of amiodarone in this setting, as alluded to in the editorial by Saltman,3 would be completely resolved.


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 References
 

  1. Yagdi T, Nalbantgil S, Ayik F, Apaydin A, Islamoglu F, Posacioglu H, et al. Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1420–1425[Abstract/Free Full Text]
  2. Yazigi A, Rahbani P, Zeid HA, Madi-Jebara S, Haddad F, Hayek G. Postoperative oral amiodarone as prophylaxis against atrial fibrillation after coronary artery surgery. J Cardiothorac Vasc Anesth. 2002;16:603–606[Medline]
  3. Saltman AE. Is it time to choose amiodarone for postoperative atrial fibrillation? J Thorac Cardiovasc Surg. 2003;125:1202–1203[Free Full Text]

Related Article

Reply to the Editor
Tahir Yagdi
J. Thorac. Cardiovasc. Surg. 2004 127: 304-305. [Extract] [Full Text] [PDF]




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