Does amiodarone work in prevention of postoperative AF for patients with CAD s/p CABG? 麻醉科 R1 楊美惠 麻醉科 R1 楊美惠

Post CABG AF incidence rate: 10%-40% Loss of normal atrial contraction CO RVR: O2 consumption Stroke, peripheral embolization, ventricular arrhythmias

Previous associated studies Hohnloser SH, Meinertz T, Dammbacher T, et al. Electrocardiographic and antiarrhythmic effects of intravenous amiodarone: results of a prospective, placebo-controlled study. Am Heart J 1991;121:89–95..

Intravenous Amiodarone for Prevention of Atrial Fibrillation After Coronary Artery Bypass Grafting Shih-Huang LEE, MD, Che-Ming Chang, MD, Ming-Jen LU, MD, Ren-Jen Lee, Jun-Jack Cheng, MD, Chi-Ren Hung, MD, and Shih- Ann Chen, MD Divisions of Cardiology and Cardiovascular Surgery, Shin Kong Wu Ho-Su Memorial Hospital, and National Yang-Ming University, Taipei, Taiwan 2000 by the Society of Thoracic Surgeons Published by Elsevier Science Inc

Prospective randomied controlled study

150 Patients Exclusion criteria- <20y/o, history of previous AF, concomitant operations such as valve replacement and aneurysmectomy, preoperative use of antiarrhythmic therapy other than digitalis, calcium-channel blockers and b-blockers, history of amiodarone side effects, use of amiodarone within 6 months, concomitant thyroid disease, abnormal liver function test results, pregnancy, preexisting bradycardia(<55BPM), uncontrolled severe heart failure. Material and Methods

Hx, PE, Lab, CXR, 2D, Doppler and color echocardiograms Study protocol ~Timing:3 days before and 5 days after operation ~Amiodarone group: loading dose of 150mg then 0.4mg/kg/hr ~Control group: 5%glucose infusions

Results Amiodarone group Control group P-value Post-CABG AF incidence rate 9(12%)26(34%)<0.01

Amiodarone group (BPM) Control group (BPM) P-value Max. Ventricular rate during AF <0.01

Conclusions incidencePerioperaitve low-dose intravenous amiodarone significantly reduces ~incidence ~ventricular rate ~duration It is well tolerated and does not increase the risk of intraoperative or postoperative complications

Modification IV v.s. Oral form? Perioperative v.s Postoperative?

Postoperative Oral Amiodarone as Prophylaxis Against Atrial Fibrillation After Coronary Artery Surgery Alexandre Yazigi, MD, Pielly Rahbani, MD, Hicham Abou Zeid, MD, Samia Madi-Jebara, MD, Fadia Haddad, MD and Gemma Hayek, MD Journal of Cardiothoracic and Vascular Anesthesia, Vol 16, No5(October), 2002:P

Study prococol Post-OP <4hr admission to ICU Sinus rhythm > 70 beats/min Free from inotropic drug support Randomized into 2 groups ~ group 1: oral 15mg/kg, then 7mg/kg/d until discharge from hospital ~ group 2: placebo

Postoperative Atrial Fibrillation Endpoints Amiodarone Placebo (n=100) (n=100) Incidence of new-onset AF(n) 12* 25 Ventricular rate response to AF(beats/min) 120 ±21 〒 135 ±24 Time to first episode of AF(d) 2.5 ± ± 1 Duration of AF <8h h >24h 0 2 Recurrent AF(n) 6 11 *p=0.016 when compared with placebo group 〒 p=0.05 when compared with placebo group

Comparison IV amiodarone Oral amiodarone Reduce AF incidence 25-55% 50% Max. VR reduced, sig(+) reduced, sig(+) Duration of AF reduced, sig(+) reduced, sig(-) Morbidity&Mortality no increase no increase