Atrial fibrillation (AF) is a common occurrence following all chest surgery. AF following esophagectomy occurs in a third of patients and is associated with increased morbidity and mortality. We evaluated the efficacy of oral amiodarone as prophylaxis of AF. Eight patients were treated in a prospective fashion with postoperative amiodarone and were compared with 16 historical controls that received no prophylaxis.
During a 34-month period (May 2001-March 2004) 34 patients underwent thoracoabdominal esophagectomy. Eight patients received prophylactic amiodarone 200mg BID via jejunostomy immediately postoperatively and continued until time of discharge. Sixteen patients underwent esophagectomy and did not receive amiodarone, these patients served as historical controls. Ten patients were excluded because of previous history of AF, supraventricular arrhythmias, pacemaker implantation, or inadequate documentation. Primary endpoints were incidence of AF and length of stay. Fisher’s exact test was used to analyze data.
Both groups were comparable in age, sex, comorbidities, and procedure performed. A total of 6/24 (25%) patients developed AF postoperatively.. In the experimental group 1/8 (12.5 %) developed AF compared to 5/16 in the control group (31.2%, p=0.32). Major complications occurred in 1/8 (12.5%) of the experimental group and 4/16 (25%, p=0.89) in the control group. Average length of stay was 11.7 days in the experimental group vs. 17 days in the control group p=0.15.
Low dose amiodarone is relatively safe following esophagectomy. Although the reduction of AF postoperatively in the experimental group was not statistically significant there is clearly a trend toward a lower occurrence and shorter length of stay. This pilot study supports the need for a randomized prospective investigation.
AF is a common occurrence following esophagectomy. Low dose amiodarone postoperatively has been used as prophylaxis in cardiac surgery, pulmonary resections, and now following esophagectomy. Prevention of AF may be useful in reducing high morbidity and mortality rates.
T. Fabian, None.