A randomized, controlled study of amiodarone for prevention of atrial fibrillation after transthoracic esophagectomy
Received 21 July 2009; received in revised form 24 December 2009; accepted 18 January 2010. published online 12 April 2010.
Objective
Atrial fibrillation is common after esophagectomy. The objective of this study was to determine the efficacy and safety of amiodarone for prevention of atrial fibrillation after transthoracic esophagectomy.
Methods
Eighty patients undergoing transthoracic esophagectomy were randomly, prospectively assigned to receive amiodarone (n = 40) or no prophylaxis (control group, n = 40). Amiodarone-treated patients received the drug by continuous infusion, initiated at the time of induction of anesthesia, at a rate of 0.73 mg/min (43.75 mg/h), and continued for 96 hours (total dose 4200 mg). The primary end point was atrial fibrillation requiring treatment. Secondary end points included any atrial fibrillation lasting longer than 30 seconds and postoperative hospital and intensive care unit stays.
Results
There were no significant differences between the amiodarone and control groups in demographic characteristics, comorbid conditions, or preoperative or postoperative use of β-blockers or calcium-channel blockers. The incidence of atrial fibrillation requiring treatment was lower in the amiodarone group than in the control group (15% vs 40%, P = .02, relative risk reduction 62.5%). There were no significant differences between the amiodarone and control groups in median hospital stay (11 days vs 12 days, P = .31) or median intensive care unit stay (68 hours vs 77 hours, p = .097). There were no significant difference between the groups in the incidences of adverse effects.
Conclusions
Amiodarone prophylaxis significantly reduced the incidence of atrial fibrillation after transthoracic esophagectomy.
aDepartment of Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, Purdue University, Indianapolis, Ind
bDepartment of Medicine, Indiana University, School of Medicine, Indianapolis, Ind
cDepartment of Surgery, Indiana University, School of Medicine, Indianapolis, Ind
dDepartment of Anesthesia, Indiana University, School of Medicine, Indianapolis, Ind
eDepartment of Pharmacy, Indiana University Hospital of Clarian Health Partners, Indianapolis, Ind
Address for reprints: James E. Tisdale, PharmD, Department of Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, Purdue University, W7555 Myers Building, WHS, 1001 W 10th St, Indianapolis, IN 46202.
Supported by a grant from the Gustavus & Louise Pfeiffer Foundation.
ABSTRACT