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PERIOPERATIVE USE OF AMIODARONE IN CARDIAC SURGERY PATIENTS TO ACHIEVE NORMAL SINUS RHYTHM UPON DISCHARGE FREE TO VIEW

Charles E. Oribabor, MD*; Naim Mansuroglu, MD; Althea Tinker; Allan Mariano; Ralph Slepian, MD; Frew Gebreab, MD; Larry H. Bernstein, MD; Leonard Lee, MD; Anthony J. Tortolani, MD
Author and Funding Information

NY Methodist Hospital, Weill Medical College of Cornell University, Brooklyn, NY


Chest


Chest. 2005;128(4_MeetingAbstracts):180S-b-181S. doi:10.1378/chest.128.4_MeetingAbstracts.180S-b
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Abstract

PURPOSE:  To use Amiodarone to achieve (1)a high rate of normal sinus rhythm at discharge in open-heart surgery patients.2-To reduce morbidity and resource utilization for postoperative atrial fibrillation in open-heart surgery patients.(3)To reduce length of stay.

METHODS:  156 patients studied prospectively.STUDY DURATION: April 1st 2004 to March 30th 2005. INCLUSION CRITERIA:(1)Age greater than 70 years old(2)Patients with an Ejection Fraction less than 30%(3)Preoperative mitral valve surgery patients(4)-Preoperative Aortic valve surgery patients(5)Preoperative Combined CABG and valve surgery patients(6)Postoperative Stanford A Aneurysm surgery patients TARGET LOAD FOR AMIODARONE LOAD: 1700mg to 2000mg(A)-Preoperative patients began there load orally. (B)-Same day patients began their load intravenously started intraoperatively.DOSING SCHEDULE:(1)Amiodarone 400mg orally twice a day for Preoperative patients(2)Amiodarone IV: 150 mg over 10 minutes,then infusion at 1mg/minute for 6 hours followed by 0.5 mg/minute over42 hours for same day patients.DISCHARGE CRITERIA(1)Amiodarone was discontinued on discharge for all patients who remained in normal sinus rhythm during their postoperative course(2)Amiodarone was continued for 2 weeks post discharge for all patients who developed postoperative atrial fibrillation but had converted to normal sinus rhythm by the time of discharge. Re-admissions for Atrial fibrillation over a 4 week period was tracked.

RESULTS:  (1)Preoperative Atrial fibrillation rate 11 %(2)Postoperative atrial fibrillation rate: 32%(2)-Discharge rate in Normal sinus rhythm: 93.78%(3)-Actual Risk reduction 61.78 %: (4)Numbers needed treat: 1.61 patients (5)Readmissions for atrial fibrillation : zero (6)Length of stay reduced to 4.9 days.

CONCLUSION:  (1)Perioperative Amiodarone use in high risk cardiac surgery patients leads to 93.78 percent discharge rate in normal sinus rhythm.(2)-No readmissions for atrial fibrillation were encountered at post discharge follow up (3)-The incidence of postoperative atrial fibrillation remains relatively high because of the length of time required to fully load patients with 1.7 to 2mg of Amiodarone.

CLINICAL IMPLICATIONS:  The attainment and maintenance of normal sinus rhythm postoperatively in open heart surgery patients with the perioperative use of Amiodarone has lead to(1)-Reduced resource utilization for the treatment of postoperative atrial fibrillation.(2)-Reduced length of stay .(3)Reduced risk of bleeding from anticoagulation.

DISCLOSURE:  Charles Oribabor, None.

Tuesday, November 1, 2005

12:30 PM - 2:00 PM


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