2.  ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend :  Oral B Blockers to prevent post operative atrial fibrillation. (IA)  Preoperative Amiodarone for high risk patients for AF. (IIa A) *Circulation. 2006 Aug 15;114(7):e257-354.

3.  The goal was to search the literature for data combining postoperative B blockers and intravenous Amiodarone for atrial fibrillation prophylaxis.

4.  Included 220 patients. Stratified for valvular surgery.  Patients had to be 60 years or older.  Admitted at least on day before surgery.

10.  Patients admitted between Jan 2001 & May 2002.  Patients with AF, MI within 2 weeks, EF less than 35% and unstable angina were excluded.  Sample size calculation done to detect a 25% difference between treatment groups & placebo.

11.  The SPPAF trial  824 patients screened and 512 excluded.  Patients were randomized to one of 4 groups.  Prophylaxis started 24 to 48 hours before surgery & continued for 8 days after.  Chronic B blockers were halved (38.3%).  Metoprolol 50 mg twice daily with oral Amiodarone 1200X2, 800X2, 400X5.

12.  The SPPAF Trial Results

14.  The SPPAF Trial

15.  Patients randomized to receive oral Amiodarone or placebo.  Treatment group received 10 mg/Kg/day of Amiodarone for 6 days preoperatively and 6 days postoperatively.  601 patients were included.

19.  Patients randomized to receive Amiodarone or placebo then atrial pacing or not.  Treatment group received 1050 mg Amio IV loading dose over 24h within 6 hours of surgery, followed by 400 mg TID for 4 days.  160 patients were included.

20.  AFIST II Trial

24.  Intravenous amiodarone or magnesium sulphate is not cost-beneficial prophylaxis for atrial fibrillation after coronary artery bypass surgery. Br J Anaesth. 2000;85:690-5.  155 patients were included.  Randomized to a 72h infusion of 900 mg/day of Amiodarone, 4 gm of MgSo4 a day, or placebo.  No difference in atrial fibrillation.  Higher rate of complications with Amiodarone. Resulted in stopping it in 4 patients.

25. Thank You