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J Thorac Cardiovasc Surg 2004;127:304-305
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor

Department of Cardiovascular Surgery, Ege University Medical Faculty, zmir, Turkey

There is no consensus about the optimal dose and route of amiodarone in prophylaxis against atrial fibrillation after coronary artery bypass grafting. In most of the studies we cited in our article,¹ intravenous amiodarone doses ranged from 10 mg/(kg · d) to 20 mg/(kg · d) through 2 to 8 days. Oral amiodarone doses ranged from 2.8 to 7.0 g through 7 to 20 days. We used relatively short-term, low-dose (10 mg/[kg · d], for 48 hours) intravenous administration, followed by oral tapered doses at a total of 9.0 g through 30 days. We prefer a combination therapy to take the advantage of accelerated loading time with the intravenous amiodarone and to obtain the incremental benefits of the oral amiodarone during the short-term intravenous administration.

We found that the postoperative administration of amiodarone was effective at significantly reducing the incidence of postoperative atrial fibrillation by 14.6%, the duration of atrial fibrillation episodes by 21.9 hours, and the ventricular response rate by 20 beats/min. In addition to the lower incidence of postoperative atrial fibrillation, the amiodarone group had significantly fewer and less severe postoperative ventricular arrhythmias than did the control group. In addition, fatal ventricular tachyarrhythmia was not seen in the amiodarone group, whereas 2 deaths in the control group were related to ventricular tachyarrhythmia. The combined intravenous and oral amiodarone regimen used in this study was well tolerated.

We also found that amiodarone prophylaxis is cost-effective even when intravenous administration is used during first 48 hours. Intravenous amiodarone use did not require additional lines or extra intensive care unit stays. Furthermore, the amiodarone group had shorter hospital stays than did the control group (6.8 days vs 7.8 days). In our protocol, the total cost of the amiodarone was only a third the cost of a single day of hospitalization.

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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
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tahir Yagdi Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yagdi, T. Search for Related Content PubMed Articles by Yagdi, T. Related Collections Electrophysiology - arrhythmias Related Article