How Should We Use the Amiodarone After Coronary Bypass Surgery? Prophylactic or Therapeutic?

Objective: The aim of this study was to assess the efficacy and side effects of postoperative administration of amiodarone as a prophylaxis for or treatment of new onset atrial fibrillation after coronary artery bypass grafting surgery. Material and Methods: Between January 2010 and January 2012, we conducted a retrospective analysis on consecutive patients who underwent coronary artery bypass grafting surgery. Patients were grouped according to whether they received amiodarone for prophylaxis or for treatment of atrial fibrillation. In Group 1, amiodarone was given after new onset atrial fibrillation for treatment (Group 1; n=595; 378 males, 217 females; mean age 62.16±4.72 years; range 43-78 years). Group 2 received amiodarone for prevention of postoperative atrial fibrillation (Group 2; n=500; 344 males, 156 females; mean age 61.43±6.12 years; range 41-81 years). The patients were followed-up for arrhythmias and left ventricular function using electrocardiography and echocar - diography. Results: Preoperative patient characteristics and operative variables were similar in two groups. Patient recovery was significantly slower in Group 1. Postoperative atrial fibrillation occurred in 595 patients among 3500 patients (17%) who underwent coronary bypass surgery without amio - darone, and in 27 patients (5.40 %) receiving amiodarone as prophylaxis (p=0.0001). Mean pulmonary and liver function tests were not significantly different between two groups. Group 2 patients had shorter hospital stays compared to Group 1 patients (Group 2: 4.9+3.6 days vs. Group 1: 6.2+5.8 days, p=0.001). The in-hospital mortality was not different between the two groups (1.5% vs. 1.2%, p=0.176, respectively). Conclusion: Postoperative prophylactic amiodarone therapy in patients undergoing coro - nary bypass surgery is well tolerated and significantly reduces the incidence of postoperative atrial ar - rhythmias while not affecting left ventricular function.