Yagdi Tahir, Nalbantgil Sanem, Ayik Fatih, Apaydin Anil, Islamoglu Fatih, Posacioglu Hakan, Calkavur Tanzer, Atay Yuksel, Buket Suat
Ege University Medical Faculty, Department of Cardiovascular Surgery, Izmir, Turkey.
J Thorac Cardiovasc Surg. 2003 Jun;125(6):1420-5. doi: 10.1016/s0022-5223(02)73292-3.
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.
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).
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).
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.
本研究旨在评估冠状动脉搭桥术患者术后预防性应用胺碘酮预防新发术后房颤的安全性和有效性。
在这项前瞻性研究中，157例患者被随机分为两组：77例患者（胺碘酮组）术后48小时静脉注射胺碘酮，剂量为10mg/kg/d。术后第2天开始口服胺碘酮，剂量为600mg/d，持续5天，随后5天为400mg/d，再后20天为200mg/d；80例患者接受安慰剂（对照组）。
两组患者术前特征和手术变量相似。接受胺碘酮治疗的患者中有8例（10.4%）发生术后房颤，接受安慰剂治疗的患者中有20例（25.0%）发生术后房颤（P = 0.017）。胺碘酮组房颤持续时间为12.8±4.8小时，而对照组为34.7±28.7小时（P = 0.003）。胺碘酮组房颤期间的最大心室率低于对照组（分别为每分钟105.9±19.1次和每分钟126.0±18.5次，P = 0.016）。两组除心律失常外的并发症发生率相似（20.8%对20.0%，P = 0.904）。胺碘酮组患者的住院时间短于对照组患者（6.8±1.7天对7.8±2.9天，P = 0.014）。两组的院内死亡率无差异（1.3%对3.8%，P = 0.620）。
术后静脉注射胺碘酮，随后口服胺碘酮，似乎对预防新发术后房颤有效。它还能降低冠状动脉搭桥术后房颤的心室率和持续时间。耐受性良好，并可缩短住院时间。
