Amiodarone Prevents Atrial Fibrillation After Coronary Artery Bypass Surgery
In patients undergoing coronary artery bypass graft surgery (CABG), the combination of intravenous and oral amiodarone given perioperatively decreases the incidence of atrial fibrillation (AF) that often occurs after the procedure, according to a report in the September issue of Chest.
Atrial fibrillation is the most common arrhythmia after CABG, the authors explain, and attempts to prevent the arrhythmia have met with mixed results.
Dr. Joshua Kerstein from Maimonides Medical Center in Brooklyn, New York and colleagues studied the effect of perioperative intravenous and oral amiodarone on the incidence of postoperative AF, length of hospital stay, and hospital costs. The total dose of amiodarone was 4,500 mg given over 5 days.
Three of 51 patients treated with amiodarone (5.9%) developed postoperative AF, the authors report, compared with 24 of 92 controls (26.9%).
Amiodarone was well tolerated, with only one discontinuation because of extreme bradycardia. There were no other clinically significant drug-related side effects.
The mean length of stay was shorter for the amiodarone group (5.3 days) than for the control group (6.7 days), the researchers note, but the difference did not reach statistical significance.
Patients who did not develop AF realized an average savings in hospital costs of $430, the investigators report. Among those who did develop AF, hospital costs remained an average of $528 per stay lower among amiodarone patients than among control patients (after excluding one control patient who had a prolonged hospital stay).
“If a conservative estimate of $500 is used, the savings for 553,000 patients per year is more than $277 million, amounting to savings that are quite substantial,” the researchers write.
“We believe that a large, multicenter, double-blinded randomized trial should be performed using the combination of IV and oral amiodarone to further elucidate whether this should become standard therapy in all patients undergoing CABG,” the authors conclude.
