ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : ...

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend:

Oral B Blockers to prevent post operative atrial fibrillation. (IA)

Preoperative Amiodarone for high risk patients for AF. (IIa A)

*Circulation. 2006 Aug 15;114(7):e257-354.

Atrial Fibrillation after Cardiac Surgery

The goal was to search the literature for data combining postoperative B blockers and intravenous Amiodarone for atrial fibrillation prophylaxis.

Atrial Fibrillation after Cardiac Surgery

Included 220 patients. Stratified for valvular surgery.

Patients had to be 60 years or older. Admitted at least on day before surgery.

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Patients admitted between Jan 2001 & May 2002.

Patients with AF, MI within 2 weeks, EF less than 35% and unstable angina were excluded.

Sample size calculation done to detect a 25% difference between treatment groups & placebo.

Atrial Fibrillation after Cardiac Surgery

The SPPAF trial 824 patients screened and 512

excluded. Patients were randomized to one of 4

groups. Prophylaxis started 24 to 48 hours

before surgery & continued for 8 days after.

Chronic B blockers were halved (38.3%). Metoprolol 50 mg twice daily with oral

Amiodarone 1200X2, 800X2, 400X5.

Atrial Fibrillation after Cardiac Surgery

The SPPAF Trial Results

Atrial Fibrillation after Cardiac Surgery

The SPPAF Trial Results

Atrial Fibrillation after Cardiac Surgery

The SPPAF Trial

Atrial Fibrillation after Cardiac Surgery

Patients randomized to receive oral Amiodarone or placebo.

Treatment group received 10 mg/Kg/day of Amiodarone for 6 days preoperatively and 6 days postoperatively.

601 patients were included.

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Patients randomized to receive Amiodarone or placebo then atrial pacing or not.

Treatment group received 1050 mg Amio IV loading dose over 24h within 6 hours of surgery, followed by 400 mg TID for 4 days.

160 patients were included.

Atrial Fibrillation after Cardiac Surgery

AFIST II Trial

Atrial Fibrillation after Cardiac Surgery

AFIST II Trial

Atrial Fibrillation after Cardiac Surgery

AFIST II Trial

Atrial Fibrillation after Cardiac Surgery

AFIST II Trial

Atrial Fibrillation after Cardiac Surgery

Intravenous amiodarone or magnesium sulphate is not cost-beneficial prophylaxis for atrial fibrillation after coronary artery bypass surgery. Br J Anaesth. 2000;85:690-5.

155 patients were included. Randomized to a 72h infusion of 900 mg/day

of Amiodarone, 4 gm of MgSo4 a day, or placebo.

No difference in atrial fibrillation. Higher rate of complications with Amiodarone.

Resulted in stopping it in 4 patients.

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