Intravenous plus oral amiodarone, atrial septal pacing, or both strategies to prevent post-cardiothoracic surgery atrial fibrillation: The atrial fibrillation suppression trial II (AFIST II)

• Published in: Circulation (New York, N.Y.) Vol. 108; no. 10; pp. 200 - 206
• Main Authors: WHITE, C. Michael, CARON, Michael F, KALUS, James S, ROSE, Heidi, SONG, Jessica, REDDY, Prabashni, GALLAGHER, Robert, KLUGER, Jeffrey
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 09.09.2003; American Heart Association, Inc
• Subjects: Administration, Oral; Aged; Amiodarone - administration & dosage; Amiodarone - therapeutic use; Atrial Fibrillation - economics; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac Pacing, Artificial; Combined Modality Therapy; Coronary Artery Bypass; Endpoint Determination; Female; Heart Atria; Heart Septum; Heart Valve Prosthesis Implantation; Hospital Costs; Humans; Infusions, Intravenous; Length of Stay; Male; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thoracic Surgical Procedures; Antianginal agent; Heart; Intravenous administration; pacemaker; Arrhythmia; Coronary vasodilator agent; Cardiovascular disease; Atrial septum; Amiodarone; Iodine Organic compounds; Prevention; Heart disease; Surgery; Phase II trial; Human; Treatment efficiency; Atrial fibrillation; Oral administration; Instrumentation therapy; Thorax; Antiarrhythmic agent; Excitability disorder; Instrumental stimulation; Chemotherapy; artificial; Treatment; Comparative study
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.0000087445.59819.6f

The effect of a hybrid intravenous and oral prophylactic amiodarone regimen on postcardiothoracic surgery (CTS) atrial fibrillation (AF) is unknown. The impact of active atrial septal pacing on post-CTS AF has not been well characterized. In addition, the effect of using both amiodarone and atrial septal pacing together to prevent atrial fibrillation is unknown. Patients (n=160) were randomized to amiodarone or placebo and then to pacing or no pacing using a 2x2 factorial design. All therapies began within 6 hours post-CTS. Amiodarone was given by intravenous infusion for the first 24 hours (1050 mg total) followed by oral therapy for 4 postoperative days (4800 mg total). Atrial septal pacing was given for 96 hours. Amiodarone reduced the risk of AF by 43% and the risk of symptomatic AF by 68% (P=0.037 and P=0.019) versus placebo. Atrial septal pacing did not reduce AF or symptomatic AF incidence versus no pacing. The risk of post-CTS AF in the patients receiving amiodarone+pacing was lower than the placebo+no pacing and the placebo+pacing groups (57.9% and 60.5% reductions, P=0.047 and P=0.040, respectively). Amiodarone given as both an intravenous and oral regimen is effective at reducing post-CTS AF but atrial septal pacing is ineffective. Combining amiodarone and pacing is better than placebo with or without pacing but not amiodarone alone.