Amiodarone versus direct current cardioversion in treatment of atrial fibrillation after cardiac surgery

Year 2019, Volume: 10 Issue: 1, 26 - 32, 21.03.2019

Emir Karaçağlar , İlyas Atar Süleyman Özbiçer , Atilla Sezgin Salih Özçobanoğlu Ayse Canan Yazici , Bülent Özin Haldun Müderrisoğlu

https://doi.org/10.18663/tjcl.519537

Cited By: 1

Abstract

Aim:  Postoperative atrial fibrillation is common after
cardiac surgery and is associated with higher rates of complications and
mortality. Despite the importance of postoperative atrial fibrillation, the
most effective management strategy for this common surgical complication
remains uncertain. The aim of this study was to evaluate the effectiveness of
amiodarone and early direct
current cardioversion to restore sinus rhythm in new onset postoperative
atrial fibrillation.

Material
and Methods: This was a prospective, open-labeled randomized- controlled trial. A
total of 50 patients who had new onset postoperative atrial fibrillation longer
than 30 minutes were enrolled in the study; 26 patients were randomized to
control group and 24 to amiodarone group. Patients in whom sinus rhythm did not
return within 24 hours, then external electrical direct current cardioversion was performed for both groups. The
primary endpoint of the study was a restoration of sinus rhythm at the 24^th
hour. Secondary endpoints needed for direct current cardioversion, success rate, sinus rhythm at discharge, sinus
rhythm at 30^th days and crossover rates.

Results: There was a significantly higher
number of patients with sinus rhythm at the 24th hour in the amiodarone group
than the control group (79.2% vs. 46.2%, p=0.022). Need for direct current cardioversion (p=0.022) and crossover ratio (p=0.021)
were significantly higher in control group than amiodarone group. Direct current cardioversion success rate, normal sinus rhythm at
discharge and 1^st month did not differ significantly between groups.

Conclusion: Amiodarone therapy seems effective in restoring sinus rhythm within 24 hours and decreases the need for direct current cardioversion.

Keywords:  antiarrhythmic
agents; atrial fibrillation; cardiovascular surgery; post-CABG 

Keywords

Antiarrhythmia agents, Atrial fibrillation, , Cardiovascular surgery, , post-CABG atrial fibrillation

Kalp cerrahisi sonrası gelişen atriyal fibrilasyon tedavisinde amiodarone ve doğru akım kardiyoversiyonun karşılaştırılması

Abstract

Amaç: Atriyal fibrilasyon kalp cerrahisinden sonra sık
görülmektedir. Postoperatif atriyal fibrilasyon komplikasyonların ve
mortalitenin artmasına neden olmaktadır. Ancak tedavisi hususunda fikir birliği
yoktur. Bu çalışmanın amacı postoperatif dönemde yeni başlayan atriyal
fibrilasyonu olan hastalarda amiodaron kullanımı ile erken dönemde doğru akım
elektriksel kardiyoversiyonun sinüs ritmininin sağlanması üzerine olan
etkilerini karşılaştırmaktır.

Gereç ve Yöntemler: Çalışma prospektif, randomize, açık
kontrollü olarak tasarlanmıştır. Çalışmaya kalp cerrahisi sonrası 30 dakikadan
uzun yeni başlangıçlı atriyal fibrilasyonu olan toplam 50 hasta alındı; 26
hasta kontrol grubuna; 24 hasta amiodaron grubuna randomize edildi. Her iki
grupta da 24 saat içinde sinüs ritminin sağlanamadığı hastalarda doğru akım
elektriksel kardiyoversiyon uygulandı. Çalışmanın birincil son noktası 24.
saatte sinüs ritminin sağlanmasıydı. Çalışmanın ikincil son noktaları ise doğru
akım elektriksel kardiyoversiyon oranı, başarı oranı, taburculukta sinüs
ritminin varlığı, 30. günde sinüs ritminin varlığı ve grup değiştirme oranıydı.

Bulgular: Amiodaron grubunda 24. saatte sinüs
ritminde olan hasta sayısı kontrol grubuna göre anlamlı olarak daha fazla
saptandı (%79,2'ye karşı %46,2, p = 0.022). Doğru akım kardiyoversiyon oranı (p
= 0,022) ve grup değiştirme oranı (p = 0,005) kontrol grubunda anlamlı derecede
yüksekti. Taburculukta ve birinci ayda sinüs ritmi varlığı ve doğru akım
kardiyoversiyon başarı oranları açısından gruplar arasında anlamlı fark
saptanmadı.

Sonuç:  Amiodaron tedavisi 24 saat içinde sinüs
ritmininin sağlanmasında etkin görünmekte ve doğru akım kardiyoversiyon
ihtiyacını azaltmaktadır.

Keywords

Amiodaron, atriyal fibrilasyon, kalp cerrahisi, doğru akım kardiyoversiyon

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