Supraventricular tachyarrythmia prophylaxis after coronary artery surgery in chronic obstructive pulmonary disease patients (early amiodarone prophylaxis trial)

• Published in: European journal of cardio-thoracic surgery Vol. 25; no. 2; pp. 224 - 230
• Main Authors: Kuralay, Erkan, Cingöz, Faruk, Kiliç, Selim, Bolcal, Cengiz, Günay, Celalettin, Demirkiliç, Ufuk, Tatar, Harun
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.02.2004; Elsevier Science
• Subjects: Aged; Amiadarone; Amiodarone - therapeutic use; Anti-Arrhythmia Agents - therapeutic use; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Coronary Artery Bypass; Female; Forced Expiratory Volume; Humans; Length of Stay; Logistic Models; Male; Medical sciences; Middle Aged; Pneumology; Postoperative Complications - prevention & control; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - physiopathology; Risk Factors; Supraventricular tachycardia; Tachycardia, Supraventricular - etiology; Tachycardia, Supraventricular - prevention & control; Amiadarone; Coronary artery bypass; Supraventricular tachycardia; Human; Lung disease; Respiratory disease; Coronary artery; Cardiovascular disease; Amiodarone; Prevention; Chronic; Treatment; Heart disease; Surgery; Bronchus disease; Early; Obstructive pulmonary disease
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2003.11.006

Objective: Supraventricular tachyarrhythmias (SVT) is common after coronary artery bypass grafting in chronic obstructive pulmonary disease (COPD). Preoperative FEV1 is the major predetermining factor of mortality, morbidity and SVT. Methods: Patients were divided into two groups according to their preoperative FEV1 values. FEV1 is <75% of predicted value in group 1 (no. 200), and ≥75% of predicted value in group 2 (no. 100). Group 1 is divided into two subgroups. SVT prophylaxis was not done in A subgroup (no. 100) whereas arrhythmia prophylaxis was done with amiodarone in all B subgroups (no. 100) in the early postoperative period. Results: Atrial fibrillation developed in 28 patients in group 1A, whereas it developed in 12 in group 1B (P=0.005). Atrial flutter developed in 10 patients in group 1A but in 3 patients in group 1B (P=0.045). Multifocal atrial tachycardia developed in 13 patients in group 1A and in 4 in group 1B (P=0.022). Multivariate analysis identified ejection fraction (P<0.002, odds ratio (OR) 0.93), inotropy requirement (P<0.001, OR 3.98) amiodarone (P<0.001, OR 0.18), and FEV1<75% of predicted value (P<0.048, OR 1.84) as predictor of SVT. There were statistically significant differences between A and B subgroups of group 1 for hospital (P<0.001) and intensive care unit (ICU) stay (P<0.001). There was also statistically significant difference between groups 1A and 2 comparison for ICU (P<0.001; 6.4±3.4 versus 1.4±0.6 days) and hospital stay (P<0.001; 17.6±8.2 versus 6.9±0.6 days). Conclusions: Early prophylactic amiodarone not only significantly reduces SVT but also reduces SVT-related hospital and ICU stay. We strongly recommend prophylactic early use of amiodarone in COPD patients.