Gill Jaskirat, Shah Ami G, Di Luozzo Gabriele, Mei Julie, Carale Justin, Huang Kristy, Mueller Anna S, Victory-Stewart Marcelina, Friedman Seana, Bagiella Emilia, Lattouf Omar, Puskas John D, Yimen Mekeleya, Bhatt Himani V
Department of Cardiothoracic Surgery and Institute of Critical Care Medicine, Mount Sinai Hospital, NY, NY, USA.
Department of Cardiothoracic Surgery, Mount Sinai Hospital, NY, NY, USA; Department of Pharmacy, Mount Sinai Morningside Medical Center, NY, NY, USA.
Heart Lung. 2025 Jul-Aug;72:85-94. doi: 10.1016/j.hrtlng.2025.03.009. Epub 2025 Apr 12.
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, with incidence increasing based on surgical complexity. While the CHA₂DS₂-VASc score has been validated to predict POAF risk, standardized prophylactic strategies remain unclear. This study evaluates the safety and efficacy of a low-dose oral amiodarone protocol for POAF prevention in high-risk patients undergoing isolated OPCAB procedures.
To evaluate the impact of low-dose amiodarone prophylaxis against POAF in high-risk patients undergoing OPCAB procedures.
This IRB-approved prospective study included all adult inpatients undergoing isolated OPCAB procedures at a single tertiary care facility between June 2018-June 2021 identified as high risk for POAF (preoperative CHADSVASc score > 2). Patients treated with amiodarone prophylaxis were compared to a retrospective historical control group which underwent similar OPCAB procedures in the same center prior to the implementation of amiodarone prophylaxis. Preoperative hospitalized inpatients received a weight-adjusted dose of oral amiodarone on each preoperative day until the day prior to surgery. Patients who were inadequately loaded (<1 g) received 150 mg of amiodarone intravenously in the operating room. Patients with intraoperative symptomatic bradycardia received temporary prophylactic epicardial pacing wires. Postoperatively, all patients received an amiodarone regimen of 200 mg orally twice daily, continued for 15 doses or until discharge. Multivariate logistic models were used to determine the effect of low-dose oral amiodarone prophylaxis on new-onset POAF.
A 10.7 % reduction in incidence of POAF requiring treatment was noted in the study group (OR=0.4; 95 % CI [0.167-0.958], p = 0.04), as well as a 12 % decrease in patients requiring AF treatment at discharge (p = 0.017), and significantly reduced time to extubation. All baseline characteristics and safety parameters were similar between groups.
The use of a low-dose amiodarone prophylaxis regimen led to significant reduction in new POAF, without apparent adverse effects. This regimen may be considered safe, effective, and feasible for implementation in high-risk OPCAB patients. Further studies in on-pump CABG and valvular patients are needed.
术后房颤（POAF）是心脏手术后常见的并发症，其发生率随手术复杂性增加而上升。虽然CHA₂DS₂-VASc评分已被证实可预测POAF风险，但标准化的预防策略仍不明确。本研究评估低剂量口服胺碘酮方案在接受孤立性非体外循环冠状动脉搭桥术（OPCAB）的高危患者中预防POAF的安全性和有效性。
评估低剂量胺碘酮预防对接受OPCAB手术的高危患者发生POAF的影响。
这项经机构审查委员会（IRB）批准的前瞻性研究纳入了2018年6月至2021年6月期间在一家三级医疗中心接受孤立性OPCAB手术且被确定为POAF高危（术前CHADSVASc评分>2）的所有成年住院患者。将接受胺碘酮预防治疗的患者与在胺碘酮预防措施实施前在同一中心接受类似OPCAB手术的回顾性历史对照组进行比较。术前住院患者在每个术前日接受根据体重调整剂量的口服胺碘酮，直至手术前一天。负荷不足（<1 g）的患者在手术室接受150 mg静脉注射胺碘酮。术中出现症状性心动过缓的患者接受临时预防性心外膜起搏导线。术后，所有患者接受每日两次口服200 mg胺碘酮的方案，持续15剂或直至出院。使用多变量逻辑模型确定低剂量口服胺碘酮预防对新发POAF的影响。
研究组中需要治疗的POAF发生率降低了10.7%（OR = 0.4；95%CI[0.167 - 0.958]，p = 0.04），出院时需要房颤治疗的患者减少了12%（p = 0.017），拔管时间显著缩短。两组之间所有基线特征和安全参数相似。
使用低剂量胺碘酮预防方案可显著降低新发POAF，且无明显不良反应。该方案在高危OPCAB患者中实施可能被认为是安全、有效且可行的。需要对体外循环冠状动脉搭桥术和瓣膜病患者进行进一步研究。
