Effects of the Prophylactic Use of Amiodarone Infusion to Prevent Postoperative Atrial Fibrillation after Cardiac Surgery

抄録

Postoperative atrial fibrillation（AF）is associated with significant morbidity after cardiac surgery. We examined the effects of a prophylactic postoperative amiodarone infusion to prevent postoperative AF. A prospective randomized study was performed in patients with a high risk of postoperative AF between March 2016 and March 2019. High risk of AF was defined as combined valve surgery, aortic valve replacement（age＞70）, or off-pump coronary bypass grafting（age＞65）. Forty-two patients were enrolled and randomly assigned to receive prophylactic amiodarone infusion（amiodarone group, n＝20）or saline infusion（control group, n＝22）. In the amiodarone group, amiodarone was infused intravenously for 48hr postoperatively（initially 125mg/10min, then 288mg/6hr, then maintenance of 1,040mg/42hr）. There were no significant differences between the two groups in age, sex, body height, body weight, surgical procedure, and perioperative use of beta blockers. The occurrence of sustained AF for＞1hr was significantly lower in the amiodarone group（30.0％）than in the control group（63.6％, p＝0.04）. The total duration of AF over one week was also significantly shorter in the amiodarone group（296.8±676.9min）than in the control group（921.4±1641.6min, p＝0.04）, as was the postoperative hospital stay（17.3±6.1 vs. 24.5±11.3 days, respectively, p＝0.01）. There were no major side effects with amiodarone infusion except for one case of bradycardia. These results show the prophylactic use of intravenous amiodarone infusion for the first 48hr of the postoperative period is a safe and effective treatment to prevent postoperative AF after cardiac surgery and to shorten the hospital stay.