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.
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.
(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.
(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.
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.
Charles Oribabor, None.