Lee Heemoon, Kim Hee Jung, Yoo Jae Suk, Kim Dong Jin, Yeom Sang Youn, Cho Kwang Ree
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea.
Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, Korea.
J Thorac Dis. 2021 Jul;13(7):4072-4082. doi: 10.21037/jtd-21-466.
The aim of this study was to evaluate the efficacy of early amiodarone-based pharmacological cardioversion for postoperative atrial fibrillation (POAF) following off-pump coronary bypass grafting (OPCAB).
A total of 507 patients who underwent OPCAB between 2015 and 2017 were categorized into POAF (n=94) and no-POAF (n=413) groups. Patients in the POAF group were treated according to the following institutional protocol: 150 mg loading dose of intravenous amiodarone, followed by oral administration with sequential maintenance doses at 600, 400, and 200 mg per day. If sinus rhythm was restored before discharge, patients were discharged without amiodarone or anticoagulants, except for dual antiplatelets.
Before discharge at index hospitalization, 97.8% of POAF patients had restored sinus rhythm. Independent risk factors for POAF were age, unstable angina, prior percutaneous transluminal coronary angioplasty, and left atrial diameter. The mean follow-up duration was 41.1±12.8 months. Freedom from overall mortality and composite events, including mortality, major bleeding requiring admission and cerebrovascular events, were similar between the 2 groups. Results were consistent after propensity-score matching.
Amiodarone-based rapid pharmacological cardioversion of POAF resulted in a high sinus rhythm conversion rate (97.9%). Rate of late adverse cardiovascular events including stroke, were low even without anticoagulation. As optimal treatment and anticoagulation guidelines for POAF after OPCAB have not yet been established, amiodarone-based treatment protocols may be considered as a useful option.
本研究旨在评估基于早期胺碘酮的药物复律对非体外循环冠状动脉搭桥术（OPCAB）后发生的术后房颤（POAF）的疗效。
将2015年至2017年间接受OPCAB的507例患者分为POAF组（n = 94）和非POAF组（n = 413）。POAF组患者按照以下机构方案进行治疗：静脉注射胺碘酮负荷剂量150mg，随后口服，依次维持剂量为每日600mg、400mg和200mg。如果在出院前恢复窦性心律，患者出院时除双联抗血小板药物外，无需服用胺碘酮或抗凝剂。
在首次住院出院前，97.8%的POAF患者恢复了窦性心律。POAF的独立危险因素为年龄、不稳定型心绞痛、既往经皮冠状动脉腔内血管成形术和左心房直径。平均随访时间为41.1±12.8个月。两组患者的总死亡率和包括死亡率、需要住院治疗的大出血和脑血管事件在内的复合事件发生率相似。倾向得分匹配后结果一致。
基于胺碘酮的POAF快速药物复律导致高窦性心律转化率（97.9%）。即使不进行抗凝，包括中风在内的晚期不良心血管事件发生率也较低。由于尚未确立OPCAB后POAF的最佳治疗和抗凝指南，基于胺碘酮的治疗方案可被视为一种有用的选择。
