心脏手术时局部应用胺碘酮：心外膜应用胺碘酮是否能预防术后心房颤动？

Topical amiodarone during cardiac surgery: Does epicardial application of amiodarone prevent postoperative atrial fibrillation?

机构信息

Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla.

出版信息

J Thorac Cardiovasc Surg. 2017 Sep;154(3):886-892. doi: 10.1016/j.jtcvs.2017.04.013. Epub 2017 Apr 13.

DOI:10.1016/j.jtcvs.2017.04.013

PMID:28495063

Abstract

OBJECTIVES

Atrial fibrillation (AF) is a common complication after cardiac surgery. Topical amiodarone on the epicardium may help prevent postoperative AF while avoiding the side effects of its systemic administration. The purpose of this study was to evaluate the all-comer strategy of epicardial amiodarone application for the prevention of postoperative AF.

METHODS

A retrospective observational study was performed that evaluated the incidence of new-onset AF in a consecutive series of cardiac surgery patients who were treated with either no amiodarone (historical control, n = 100), epicardial application of amiodarone mixed in a topical hydrogel (n = 50), or epicardial application of an amiodarone-soaked sealant patch (n = 50). Perioperative data were compared between the 3 groups, with all patients receiving continuous postoperative telemetry to monitor for new-onset AF.

RESULTS

The cohort consisted of 200 cardiac surgery patients (coronary bypass 82%, valve surgery 24%) who had no history of AF (mean age 71.0 years, 28% female). Among the 3 groups, the incidence of postoperative AF did not significantly differ, with 29 of 100 (29%) patients in the historical control group having new AF, compared with 18 of 50 (36%) in the amiodarone-hydrogel group, and 18 of 50 (36%) in the amiodarone-patch group (P = .56). The results did not differ when the analysis was restricted to coronary bypass patients only (n = 142, 27% vs 38% vs 32%, no-amiodarone vs amiodarone-hydrogel vs amiodarone-patch, respectively, P = .56). In multivariate logistic regression analysis, only older age (P = .001) was significantly associated with new-onset AF, but the use of topical amiodarone was not.

CONCLUSIONS

Routine epicardial application of topical amiodarone was not associated with a reduction in the incidence of new-onset postoperative AF in this observational study of older patients, leading us to question its role in contemporary cardiac surgical practice.

摘要

目的

心房颤动（AF）是心脏手术后的常见并发症。心脏外膜局部应用胺碘酮有助于预防术后 AF，同时避免其全身给药的副作用。本研究的目的是评估心脏外膜应用胺碘酮预防术后 AF 的综合策略。

方法

回顾性观察研究评估了连续接受心脏手术的患者中新发 AF 的发生率，这些患者接受了以下治疗：无胺碘酮（历史对照组，n=100）、心脏外膜应用胺碘酮混合在局部水凝胶中（n=50）或心脏外膜应用胺碘酮浸泡的密封剂贴剂（n=50）。比较了 3 组的围手术期数据，所有患者均接受术后连续遥测以监测新发 AF。

结果

该队列包括 200 名心脏手术患者（冠状动脉旁路移植术 82%，瓣膜手术 24%），无 AF 病史（平均年龄 71.0 岁，28%为女性）。在 3 组中，术后 AF 的发生率无显著差异，历史对照组 100 例患者中有 29 例（29%）发生新 AF，胺碘酮-水凝胶组 50 例患者中有 18 例（36%），胺碘酮-贴剂组 50 例患者中有 18 例（36%）（P=.56）。当分析仅限于冠状动脉旁路移植术患者时（n=142，27% vs 38% vs 32%，无胺碘酮 vs 胺碘酮-水凝胶 vs 胺碘酮-贴剂，分别为 P=.56），结果也没有差异。多变量逻辑回归分析显示，只有年龄较大（P=.001）与新发 AF 显著相关，而心脏外膜局部应用胺碘酮则不然。