A comparative study between amiodarone and magnesium sulfate as antiarrhythmic agents for prophylaxis against atrial fibrillation following lobectomy
- 629 Downloads
Atrial fibrillations are common after thoracic surgery. Amiodarone and magnesium sulfate have been used for the management of atrial fibrillation following cardiac and non-cardiac surgery. However, to our knowledge, comparisons of both drugs with each other and with a control group in relation to the prevention of AF following lung surgery have not been performed. Our primary aim in this study was to prospectively evaluate the prophylactic effects of magnesium sulfate and amiodarone used separately and compare them with a control group analyzed retrospectively during and following lobectomy surgeries.
Patients and methods
The prophylactic value of amiodarone (group A; 219 patients) administered as an intravenous infusion (15 mg/kg for 48 h postoperatively) after a loading dose (5 mg/kg) was compared with magnesium sulfate (group M; 219 patients) administered intravenously as a loading dose (80 mg/kg magnesium sulfate over 30 min preoperatively) and then as an intravenous infusion (8 mg/kg/h for 48 h) in 438 patients undergoing lobectomy. These two groups were compared with a control group of 219 patients who were analyzed retrospectively.
The results showed significantly lower incidences of AF in groups A and M when compared with group C (P < 0.05). There was no significant difference between the amiodarone and magnesium sulfate groups. However, the incidence of postoperative AF was lower in the amiodarone group, where only 21 (10 %) patients developed AF in comparison to 27 (12.5 %) patients in the magnesium sulfate group. Group C showed a higher incidence, 44 (20.5 %) patients, when compared with both groups. In addition, there were significant differences between the three groups concerning intensive care unit (ICU) and total hospital stays (P < 0.05).
Our study showed that during the intra- and postoperative periods, both amiodarone and magnesium sulfate are effective at preventing the incidence of atrial fibrillation following lung resection surgery in comparison to the control group.
KeywordsMagnesium sulfate Amiodarone Atrial fibrillation Lobectomy
- 2.Vaporciyan AA, Correa AM, Rice DC, Roth JA, Smythe WR, Swisher SG. Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg. 2004;95:537–43.Google Scholar
- 5.Chelazzi C, Villa G, De Gaudio AR. Postoperative atrial fibrillation. ISRN Cardiol. 2011;203179.Google Scholar
- 7.Cook RC, Humphries KH, Gin K, Janusz MT, Slavik RS, Bernstein V, Tholin M, Lee MK. Prophylactic intravenous magnesium sulphate in addition to oral β-blockade does not prevent atrial arrhythmias after coronary artery or valvular heart surgery. Circulation. 2009;120:s163–9.PubMedCrossRefGoogle Scholar
- 8.Terzi A, Furlan G, Chiavacci P, Dal Corso B, Luzzani A, Dalla Volta S. Prevention of atrial tachyarrhythmias after non-cardiac thoracic surgery by infusion of magnesium sulfate. Thorac Cardio Vasc Surg. 1996;44:300–3.Google Scholar
- 12.Nikolaos B, Michalis V. Is amiodarone a safe antiarrhythmic to use in supraventricular tachyarrhythmias after lung cancer surgery? BMC Surg. 2004;4(7):1–6.Google Scholar
- 13.Fuster V, Rydén LE, Cannom DS. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114(7):e257–354. doi: 10.1161/CIRCULATIONAHA.106.177292PMID16908781.PubMedCrossRefGoogle Scholar
- 14.Kamei M, Morita S, Hayashi Y, Kanmura Y, Kuro M. Carvedilol versus metoprolol for the prevention of atrial fibrillation after off-pump coronary artery bypass surgery: rationale and design of the carvedilol or metoprolol post-revascularization atrial fibrillation controlled trial (COMPACT). Cardiovasc Drugs Ther. 2006;20:219–27.PubMedCrossRefGoogle Scholar
- 21.Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, Browner SW. Multicenter study of perioperative ischemia research group atrial fibrillation following coronary artery bypass graft surgery. Predictors, outcomes, and resource utilization. JAMA. 1996;276:300–6.PubMedCrossRefGoogle Scholar
- 24.Aerra V, Kuduvalli M, Moloto AN, Srinivasan AK, Grayson AD, Fabri BM, Oo AY. Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis. J Cardiothorac Surg. 2006;1(6):1–5.Google Scholar
- 26.Omae T, Kanmura Y. Management of postoperative atrial fibrillation. J Anesth. 2012;26:429–37.Google Scholar
- 31.Sood N, Coleman CI, Kluger J, White CM, Padala A, Baker WL. The association among blood transfusions, white blood cell count, and the frequency of post-cardiothoracic surgery atrial fibrillation: a nested cohort study from the Atrial Fibrillation Suppression Trials I, II, and III. J Cardiothorac Vasc Anesth. 2009;23(1):22–7.PubMedCrossRefGoogle Scholar
- 32.Haghjoo M, Saravi M, Hashmi M, Hosseini S, Givtaj N, Ghafarinejad M, Khamoushi A, Emkanjoo Z, Fazelifar A, Alizadeh A, Sadr-Ameli M. Optimal beta-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: carvedilol versus metoprolol. Heart Rhythm. 2007;4:1170–4.Google Scholar