Postoperative oral amiodarone versus oral bisoprolol as prophylaxis against atrial fibrillation after coronary artery bypass graft surgery: A prospective randomized trial

Department of Cardiovascular Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
International journal of cardiology (Impact Factor: 4.04). 09/2008; 137(2):116-22. DOI: 10.1016/j.ijcard.2008.06.034
Source: PubMed


Postoperative atrial fibrillation (AF) occurs in up to 50% of patients undergoing coronary artery bypass (CABG) surgery and is associated with complications. Amiodarone and beta blockers are effective as prophylaxis for AF after CABG. The purpose of this study was to compare oral amiodarone versus oral bisoprolol for prevention of AF after CABG.
In this randomized study, 200 patients admitted for elective CABG were given oral amiodarone (n=98 patients) or oral bisoprolol (n=102 patients) beginning 6 h after surgery. Amiodarone patients received 15 mg/Kg then 7 mg/Kg/day for one month. Bisoprolol patients received 2.5 mg then 2.5 mg bid indefinitely.
Postoperative AF occurred in 15.3% of the patients in the amiodarone group and 12.7% of the patients in the bisoprolol group (p=0.60). Maximal ventricular rate tended to be lower in the bisoprolol group (125+/-6 beats/min) compared with the amiodarone group (144+/-7 beats/min, p=.06). Preoperative beta blockage did not affect AF incidence in either study group. There was no difference between the 2 groups for the onset time of AF episodes, total AF duration, AF recurrence and postoperative length of hospital stay. No serious postoperative complications occurred in the two study groups. Two reversible low cardiac output cases occurred with bisoprolol.
Postoperative oral bisoprolol and amiodarone are equally effective for prophylaxis of AF after CABG. Treatment with bisoprolol resulted in a trend to lower ventricular response rate in AF cases. Both regimens were well tolerated.

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    • "Both study groups were significantly effective in the prevention of post-CABG AF with respect to control group (p < 0.01 in group i and p < 0.001 in group ii versus control). Sleilaty et al [61], randomized 200, admitted for elective CABG to receive oral amiodarone or oral bisoprolol beggining 6 hrs after surgery. Amiodarone patients received 15 mg/kg, followed by 7 mg/kg/d until discharge and then 200 mg/d for one month. "
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    ABSTRACT: Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery. Its incidence varies depending on type of surgery. Postoperative AF may cause hemodynamic deterioration, predispose to stroke and increase mortality. Effective treatment for prophylaxis of postoperative AF is vital as reduces hospitalization and overall morbidity. Beta-blockers, have been proved to prevent effectively atrial fibrillation following cardiac surgery and should be routinely used if there are no contraindications. Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. Other agents such as magnesium, calcium channels blocker or non-antiarrhythmic drugs as glycose-insulin--potassium, non-steroidal anti-inflammatory drugs, corticosteroids, N-acetylcysteine and statins have been studied as alternative treatment for postoperative AF prophylaxis.
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    ABSTRACT: This study was aimed to compare the results of post operative biatrial pacing and IV amiodarone in prevention of AF. In a single blind randomized clinical trial, 210 patients scheduled for elective CABG surgery were randomized either to receive overdrive biatrial pacing, IV amiodarone or no intervention. Incidence of AF postoperatively evaluated. Pacing was successful in 83% of patients and 80% of patients in amiodarone group could receive their drug. Twenty and one patients developed AF. Incidence of AF in pace, amiodarone and control group was 10.7, 5.3 and 17.9%, respectively (p = 0.08). Comparing incidence of AF between pacing and control group, the difference was not significant (p = 0.2), but the difference between amiodarone and control groups was significant statistically (p = 0.03). Patients who developed AF were older but their left ventricular ejection fraction was not different with patients without AF. The ICU stay was higher in patients with AF. Use of IV amiodarone was more effective than biatrial pacing in prevention of post operative AF and we recommend use of this drug in high risk patients.
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