Yarlagadda Chetan, Abutineh Mohamed A, Datir Rohan R, Travis Levi M, Dureja Rohan, Reddy Akshay J, Packard Jacqueline M, Patel Rakesh
Medicine, Miller School of Medicine, University of Miami, Miami, USA.
Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA.
Cureus. 2024 Apr 10;16(4):e57963. doi: 10.7759/cureus.57963. eCollection 2024 Apr.
Antiarrhythmic drugs play a pivotal role in managing and preventing arrhythmias. Amiodarone, classified as a class III antiarrhythmic, has been used prophylactically to effectively prevent atrial fibrillation postoperatively in cardiac surgeries. However, there is a lack of consensus on the use of amiodarone and other antiarrhythmic drugs as prophylaxis to reduce the occurrence of all types of postoperative arrhythmias in cardiac and non-cardiac surgeries. A comprehensive PubMed query yielded 614 relevant papers, of which 52 clinical trials were analyzed. The data collection included the class of antiarrhythmics, timing or method of drug administration, surgery type, type of arrhythmia and its incidence, and hospitalization length. Statistical analyses focused on prophylactic antiarrhythmics and their respective reductions in postoperative arrhythmias and hospitalization length. Prophylactic amiodarone alone compared to placebo demonstrated a significant reduction in postoperative arrhythmia incidence in cardiac and non-cardiac surgeries (24.01%, p<0.0001), and it was the only treatment group to significantly reduce hospitalization length versus placebo (p = 0.0441). Prophylactic use of class 4 antiarrhythmics versus placebo also demonstrated a significant reduction in postoperative arrhythmia incidence (28.01%, p<0.0001), and while there was no significant statistical reduction compared to amiodarone (4%, p=0.9941), a lack of abundant data provides a case for further research on the prophylactic use of class 4 antiarrhythmics for this indication. Amiodarone prophylaxis remains a prime cornerstone of therapy in reducing postoperative arrhythmia incidence and hospitalization length. Emerging data suggests a need for a broader exploration of alternative antiarrhythmic agents and combination therapies, particularly class 4 antiarrhythmics, in both cardiac and non-cardiac surgeries. This meta-analysis depicts the effectiveness of amiodarone, among other antiarrhythmics, in postoperative arrhythmia incidence and hospitalization length reduction in cardiac and non-cardiac surgeries.
抗心律失常药物在心律失常的管理和预防中起着关键作用。胺碘酮被归类为III类抗心律失常药物，已被预防性用于有效预防心脏手术术后房颤。然而，对于使用胺碘酮和其他抗心律失常药物作为预防措施以减少心脏和非心脏手术中各类术后心律失常的发生，目前尚无共识。一项全面的PubMed检索共得到614篇相关论文，其中对52项临床试验进行了分析。数据收集包括抗心律失常药物类别、给药时间或方法、手术类型、心律失常类型及其发生率以及住院时间。统计分析聚焦于预防性抗心律失常药物及其对术后心律失常和住院时间的各自降低作用。单独使用预防性胺碘酮与安慰剂相比，在心脏和非心脏手术中术后心律失常发生率显著降低（24.01%，p<0.0001），并且它是唯一与安慰剂相比显著缩短住院时间的治疗组（p = 0.0441）。预防性使用IV类抗心律失常药物与安慰剂相比，术后心律失常发生率也显著降低（28.01%，p<0.0001），虽然与胺碘酮相比无显著统计学差异（4%，p = 0.9941），但缺乏丰富数据为进一步研究IV类抗心律失常药物在此适应症的预防性使用提供了依据。胺碘酮预防仍然是降低术后心律失常发生率和住院时间的主要治疗基石。新出现的数据表明，需要更广泛地探索替代抗心律失常药物和联合治疗方法，特别是IV类抗心律失常药物，用于心脏和非心脏手术。这项荟萃分析描述了胺碘酮以及其他抗心律失常药物在降低心脏和非心脏手术术后心律失常发生率和住院时间方面的有效性。
