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

Öz

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 

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

• Amiodaron,atriyal fibrilasyon,kalp cerrahisi,doğru akım kardiyoversiyon

Kaynakça

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