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Amiodarone Versus Propafenone to Treat Atrial Fibrillation after Coronary Artery Bypass Grafting: A Randomized Double Blind Controlled Trial

  • Nemati, Mohammad Hassan (Department of Cardiothoracic Surgery, Shiraz University of Medical Sciences) ;
  • Astaneh, Behrooz (Medical Journalism Department, Paramedical School, Shiraz University of Medical Sciences)
  • Received : 2015.09.04
  • Accepted : 2016.02.12
  • Published : 2016.06.05

Abstract

Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Several therapeutic and preventive strategies have been introduced for postoperative AF, but the treatment and prophylaxis of AF remain controversial. We aimed to compare the efficacy of intravenous amiodarone and oral propafenone in the treatment of AF after coronary artery bypass grafting (CABG). Methods: This was a randomized controlled trial performed in two hospitals in Shiraz, Iran from 2009 to 2012. We included all patients who underwent elective CABG and developed AF postoperatively. The patients were randomly assigned to receive propafenone or amiodarone. The duration of AF, the success rate of the treatment, the need for cardioversion, the frequency of repeated AF, and the need for repeating the treatment were compared. Results: The duration of the first (p=0.361), second (p=0.832), and third (p=0.298) episodes of AF, the need for cardioversion (p=0.998), and the need to repeat the first and second doses of drugs (p=0.557, 0.699) were comparable between the study groups. Repeated AF was observed in 17 patients (30.9%) in the propafenone group and 23 patients (34.3%) in the amiodarone group (p=0.704). Conclusion: Oral propafenone and intravenous amiodarone are equally effective in the treatment and conversion of recent-onset AF after CABG.

Keywords

References

  1. Hogue CW Jr, Hyder ML. Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. Ann Thorac Surg 2000;69:300-6. https://doi.org/10.1016/S0003-4975(99)01267-9
  2. Mariscalco G, Engstrom KG. Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery. Ann Thorac Surg 2009;88:1871-6. https://doi.org/10.1016/j.athoracsur.2009.07.074
  3. Mathew JP, Parks R, Savino JS, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA 1996;276:300-6. https://doi.org/10.1001/jama.1996.03540040044031
  4. Cox JL. A perspective of postoperative atrial fibrillation in cardiac operations. Ann Thorac Surg 1993;56:405-9. https://doi.org/10.1016/0003-4975(93)90871-E
  5. Kaw R, Hernandez AV, Masood I, Gillinov AM, Saliba W, Blackstone EH. Short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 2011;141:1305-12. https://doi.org/10.1016/j.jtcvs.2010.10.040
  6. Mitchell LB, Crystal E, Heilbron B, Page P. Atrial fibrillation following cardiac surgery. Can J Cardiol 2005;21 Suppl B:45B-50B.
  7. Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med 1997;336:1429-34. https://doi.org/10.1056/NEJM199705153362006
  8. Burashnikov A, Antzelevitch C. New pharmacological strategies for the treatment of atrial fibrillation. Ann Noninvasive Electrocardiol 2009;14:290-300. https://doi.org/10.1111/j.1542-474X.2009.00305.x
  9. Burashnikov A, Antzelevitch C. Novel pharmacological targets for the rhythm control management of atrial fibrillation. Pharmacol Ther 2011;132:300-13. https://doi.org/10.1016/j.pharmthera.2011.08.002
  10. Heldal M, Atar D. Pharmacological conversion of recent-onset atrial fibrillation: a systematic review. Scand Cardiovasc J Suppl 2013;47:2-10. https://doi.org/10.3109/14017431.2012.740572
  11. Levy S, Lauribe P, Dolla E, et al. A randomized comparison of external and internal cardioversion of chronic atrial fibrillation. Circulation 1992;86:1415-20. https://doi.org/10.1161/01.CIR.86.5.1415
  12. Alt E, Ammer R, Schmitt C, et al. A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion. Eur Heart J 1997;18:1796-804. https://doi.org/10.1093/oxfordjournals.eurheartj.a015175
  13. Azpitarte J, Alvarez M, Baun O, et al. Value of single oral loading dose of propafenone in converting recent-onset atrial fibrillation: results of a randomized, double-blind, controlled study. Eur Heart J 1997;18:1649-54. https://doi.org/10.1093/oxfordjournals.eurheartj.a015146
  14. Capucci A, Villani GQ, Aschieri D, Piepoli M. Safety of oral propafenone in the conversion of recent onset atrial fibrillation to sinus rhythm: a prospective parallel placebo-controlled multicentre study. Int J Cardiol 1999;68:187-96. https://doi.org/10.1016/S0167-5273(98)00363-5
  15. Andrivet P, Boubakri E, Dove PJ, Mach V, Vu Ngoc C. A clinical study of amiodarone as a single oral dose in patients with recent-onset atrial tachyarrhythmia. Eur Heart J 1994; 15:1396-402. https://doi.org/10.1093/oxfordjournals.eurheartj.a060401
  16. Khan IA, Mehta NJ, Gowda RM. Amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation. Int J Cardiol 2003;89:239-48. https://doi.org/10.1016/S0167-5273(02)00477-1
  17. Kochiadakis GE, Igoumenidis NE, Parthenakis FI, Chlouverakis GI, Vardas PE. Amiodarone versus propafenone for conversion of chronic atrial fibrillation: results of a randomized, controlled study. J Am Coll Cardiol 1999;33:966-71. https://doi.org/10.1016/S0735-1097(98)00678-0
  18. Blanc JJ, Voinov C, Maarek M. Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation. PARSIFAL Study Group. Am J Cardiol 1999;84:1029-32. https://doi.org/10.1016/S0002-9149(99)00493-2
  19. Martinez-Marcos FJ, Garcia-Garmendia JL, Ortega-Carpio A, Fernandez-Gomez JM, Santos JM, Camacho C. Comparison of intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm. Am J Cardiol 2000;86:950-3. https://doi.org/10.1016/S0002-9149(00)01128-0
  20. Zebis LR, Christensen TD, Thomsen HF, et al. Practical regimen for amiodarone use in preventing postoperative atrial fibrillation. Ann Thorac Surg 2007;83:1326-31. https://doi.org/10.1016/j.athoracsur.2006.09.096
  21. Zebis LR, Christensen TD, Kristiansen IS, Hjortdal VE. Amiodarone cost effectiveness in preventing atrial fibrillation after coronary artery bypass graft surgery. Ann Thorac Surg 2008;85:28-32. https://doi.org/10.1016/j.athoracsur.2007.07.060
  22. Ito N, Tashiro T, Morishige N, et al. Efficacy of propafenone hydrochloride in preventing postoperative atrial fibrillation after coronary artery bypass grafting. Heart Surg Forum 2010;13:E223-7. https://doi.org/10.1532/HSF98.20091173
  23. Eremenko AA, Galanikhina EA, Ziuliaeva TP, Egorov VM. Efficacy of amiodarone versus propafenone in the prevention of rhythm disorders in patients after aortocoronary bypass surgery. Anesteziol Reanimatol 2010;(5):45-9.
  24. Larbuisson R, Venneman I, Stiels B. The efficacy and safety of intravenous propafenone versus intravenous amiodarone in the conversion of atrial fibrillation or flutter after cardiac surgery. J Cardiothorac Vasc Anesth 1996;10:229-34. https://doi.org/10.1016/S1053-0770(96)80243-6
  25. Di Biasi P, Scrofani R, Paje A, Cappiello E, Mangini A, Santoli C. Intravenous amiodarone vs propafenone for atrial fibrillation and flutter after cardiac operation. Eur J Cardiothorac Surg 1995;9:587-91. https://doi.org/10.1016/S1010-7940(05)80011-9
  26. Edvardsson N. Comparison of class I and class III action in atrial fibrillation. Eur Heart J 1993;14 Suppl H:62-6. https://doi.org/10.1093/eurheartj/14.suppl_H.62
  27. Wang J, Bourne GW, Wang Z, Villemaire C, Talajic M, Nattel S. Comparative mechanisms of antiarrhythmic drug action in experimental atrial fibrillation: importance of use-dependent effects on refractoriness. Circulation 1993;88:1030-44. https://doi.org/10.1161/01.CIR.88.3.1030
  28. Aranki SF, Shaw DP, Adams DH, et al. Predictors of atrial fibrillation after coronary artery surgery: current trends and impact on hospital resources. Circulation 1996;94:390-7. https://doi.org/10.1161/01.CIR.94.3.390
  29. Redle JD, Khurana S, Marzan R, et al. Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass surgery. Am Heart J 1999;138(1 Pt 1):144-50. https://doi.org/10.1016/S0002-8703(99)70260-7
  30. Davison R, Hartz R, Kaplan K, Parker M, Feiereisel P, Michaelis L. Prophylaxis of supraventricular tachyarrhythmia after coronary bypass surgery with oral verapamil: a randomized, double-blind trial. Ann Thorac Surg 1985;39:336-9. https://doi.org/10.1016/S0003-4975(10)62626-4
  31. Nystrom U, Edvardsson N, Berggren H, Pizzarelli GP, Radegran K. Oral sotalol reduces the incidence of atrial fibrillation after coronary artery bypass surgery. Thorac Cardiovasc Surg 1993;41:34-7. https://doi.org/10.1055/s-2007-1013817
  32. Lamb RK, Prabhakar G, Thorpe JA, Smith S, Norton R, Dyde JA. The use of atenolol in the prevention of supraventricular arrhythmias following coronary artery surgery. Eur Heart J 1988;9:32-6. https://doi.org/10.1093/ehj/9.1.32