A comparative study between amiodarone and magnesium sulfate as antiarrhythmic agents for prophylaxis against atrial fibrillation following lobectomy



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.

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  1. 1.

    Von Koring J, Lepantalo M, Lindgren L, Lindfors O. Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer. Ann Thorac Surg. 1992;53:642–7.

    Article  Google Scholar 

  2. 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 

  3. 3.

    Amar D, Zhang H, Roistacher N. The incidence and outcome of ventricular arrhythmias after noncardiac thoracic surgery. Anesth Analg. 2002;95:537–43.

    PubMed  Google Scholar 

  4. 4.

    Sekine Y, Kesler KA, Behnia M, Brooks-Brunn J, Sekine E, Brown JW. COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer. Chest. 2001;120:1783–90.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Chelazzi C, Villa G, De Gaudio AR. Postoperative atrial fibrillation. ISRN Cardiol. 2011;203179.

  6. 6.

    Tiryakioglu O, Demirtas S, Ari H, Tiryakioglu SK, Huysal K, Selimoglu O, Ozyazicioglu A. Magnesium sulphate and amiodarone prophylaxis for prevention of postoperative arrhythmia in coronary by-pass operations. J Cardiothorac Surg. 2009;4:8.

    PubMed  Article  Google Scholar 

  7. 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.

    PubMed  Article  CAS  Google Scholar 

  8. 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 

  9. 9.

    Lanza LA, Visbal AI, DeValeria PA, Zinsmeister AR, Diehl NN, Trastek VF. Low-dose oral amiodarone prophylaxis reduces atrial fibrillation after pulmonary resection. Ann Thorac Surg. 2003;75:223–30.

    PubMed  Article  Google Scholar 

  10. 10.

    Hazelrigg SR, Boley TM, Cetindag IB, Moulton PK, Trammell LG, Polancic EJ, Shawgo ST, Quin AJ, Verhulst S. The efficacy of supplemental magnesium in reducing atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg. 2004;77:824–30.

    PubMed  Article  Google Scholar 

  11. 11.

    Koniari I, Apostokalis E, Rogkakou C, Baikoussis N, Dougenis D. Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review. J Cardiothorac Surg. 2010;5:121.

    PubMed  Article  Google Scholar 

  12. 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. 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.

    PubMed  Article  Google Scholar 

  14. 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.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Ciriaco P, Mazzone P, Canneto B, Zannini P. Supraventricular arrhythmia following lung resection for non-small cell lung cancer and its treatment with amiodarone. Eur J Cardiothorac Surg. 2000;18:12–6.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Rena O, Papalia E, Oliaro A, Cascadio C, Ruffini E, Filosso PL, Sacerdote C, Maggi G. Supraventricular arrhythmias after resection surgery of the lung. Eur J Cardiothorac Surg. 2001;20:688–93.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Cardinale D, Martinoni A, Cipolla CM, Lamantia G, Fiortanini C, Mezzetti M. Atrial fibrillation after operation for lung cancer. Clinical and prognostic significance. Ann Thorac Surg. 1999;68:1827–31.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Asamura H, Naruka T, Tsuchiya R, Goya T, Kondo H, Suemasu K. What are the risk factors for arrhythmias after thoracic operations? A retrospective multivariate analysis of 267 consecutive thoracic operations. J Thorac Cardiovasc Surg. 1993;106:1104–10.

    PubMed  CAS  Google Scholar 

  19. 19.

    Amar D, Roistacher N, Burt M, Reinsel RA, Ginsberg RJ, Wilson RS. Clinical and echocardiographic correlates of symptomatic tachydysrhythmias after noncardiac thoracic surgery. Chest. 1995;108:349–54.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation. Population-based estimates. Am J Cardiol. 1998;82:2N–9N.

    PubMed  Article  CAS  Google Scholar 

  21. 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.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Van MW, Coolen L, Malysse I, Lacquet LM, Deneffe GJ, Demedts MG. Amiodarone and the development of ARDS after lung surgery. Chest. 1994;105(6):1642–5.

    Article  Google Scholar 

  23. 23.

    Forlani S, De Paulis R, De Notaris S, Nardi P, Tomai F, Proietti I, Ghini A, Chiariello L. Combination of sotalol and magnesium prevents atrial fibrillation after coronary artery bypass grafting. Ann Thorac surg. 2002;74:720–6.

    PubMed  Article  Google Scholar 

  24. 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 

  25. 25.

    Satur CM. Magnesium and cardiac surgery. Ann R Coll Surg Engl. 1997;79:349–54.

    PubMed  CAS  Google Scholar 

  26. 26.

    Omae T, Kanmura Y. Management of postoperative atrial fibrillation. J Anesth. 2012;26:429–37.

    Google Scholar 

  27. 27.

    England MR, Gordon G, Salem M, Chernow B. Magnesium administration and dysrhythmias after cardiac surgery: a placebo controlled, double blind, randomized trial. JAMA. 1992;268:2395–402.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Onalon O, Crystal E, Daoulah A, Lau C, Crystal A, Lashesky I. Metaanalysis of magnesium therapy for the acute management of rapid atrial fibrillation. Am J Cardiol. 2007;99(12):1726–32.

    Article  Google Scholar 

  29. 29.

    Hague CW Jr, Creswell LL, Gutterman DD, Fleisher LA. Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005;128(2 suppl):9S–16S.

    Article  Google Scholar 

  30. 30.

    Christians KK, Wu B, Quebbeman EJ, Brasel KJ. Postoperative atrial fibrillation in noncardiothoracic surgical patients. Am J Surg. 2001;182(6):713–5.

    PubMed  Article  CAS  Google Scholar 

  31. 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.

    PubMed  Article  Google Scholar 

  32. 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 

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Correspondence to Mohamed A. Khalil.

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Khalil, M.A., Al-Agaty, A.E., Ali, W.G. et al. A comparative study between amiodarone and magnesium sulfate as antiarrhythmic agents for prophylaxis against atrial fibrillation following lobectomy. J Anesth 27, 56–61 (2013). https://doi.org/10.1007/s00540-012-1478-3

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  • Magnesium sulfate
  • Amiodarone
  • Atrial fibrillation
  • Lobectomy