Department of Quantitative and Population Health Sciences
Cardiology | Cardiovascular Diseases
Background: In randomized controlled trials, perioperative administration of amiodarone has been shown to reduce the incidence of postoperative atrial arrhythmias and length of stay (LOS) among patients undergoing coronary bypass surgery. However, little is known about the use or effectiveness of perioperative amiodarone in routine clinical practice.
Methods and Results: We studied patients > /=18 years old without a previous history of atrial or ventricular arrhythmias who underwent elective coronary bypass surgery between 2013 and 2014 within a network of 235 US hospitals. Perioperative amiodarone was defined as receipt of amiodarone either on the day of or the day preceding surgery. We used covariate-adjusted modeling and instrumental variable methods to examine the association between receipt of amiodarone and the development of atrial arrhythmias, in-hospital mortality, readmission, LOS, and cost. Of 12 758 patients, 2195 (17.2%) received perioperative amiodarone, 3330 (26.1%) developed atrial arrhythmias postoperatively, and the average LOS was 6.4 days (+/-2.6 days). Instrumental variable analysis showed that receipt of perioperative amiodarone was associated with lower risk of atrial arrhythmias (risk difference -11 percentage points, 95% CI -19 to -4 percentage points; P=0.002) and a shorter LOS (-0.7 day, 95% CI -1.39 to -0.01 days; P=0.048). There was no association between receipt of perioperative amiodarone and in-hospital mortality, cost, or readmission.
Conclusions: Among patients undergoing coronary bypass surgery without previous arrhythmias, perioperative amiodarone is associated with a lower risk of atrial arrhythmias and shorter LOS. These findings are consistent with previous randomized trials and lend support to current guideline recommendations.
amiodarone, atrial fibrillation arrhythmia, coronary artery bypass graft surgery, heart valve surgery, postoperative complication arrhythmia
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Copyright 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
DOI of Published Version
J Am Heart Assoc. 2019 Aug 6;8(15):e009892. doi: 10.1161/JAHA.118.009892. Epub 2019 Aug 5. Link to article on publisher's site
Journal of the American Heart Association
Atreya AR, Priya A, Pack QR, Pekow PS, Stefan M, Lagu T, Lotfi AS, Lindenauer PK. (2019). Use and Outcomes Associated With Perioperative Amiodarone in Cardiac Surgery. Open Access Publications by UMass Chan Authors. https://doi.org/10.1161/JAHA.118.009892. Retrieved from https://escholarship.umassmed.edu/oapubs/3951
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.