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Perioperative use of amiodarone in radiofrequency modified maze procedure for chronic atrial fibrillation

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Introduction

Atrial fibrillation [AF] is the most common sustained arrhythmia encountered in clinical practice. This study compares the efficacy of modified maze using radiofrequency [RF] microbipolar coagulation and cryoablation with and without perioperative amiodarone.

Patients and Methods

This study includes 88 patients rheumatic heart disease with RHD with chronic AF undergoing valvular heart surgery. Initial 30 patients underwent RF modified maze with perioperative amiodarone cover that was continued for 3 weeks postoperatively. Following that 58 patients underwent RF maze without amiodarone in the first week following surgery. Amongst these, patients who were still in AF on 7th postoperative day were cardioverted with DC shock and then started on amiodarone if no response was achieved. These patients were studied in 2 grps A&B. Both the groups were comparable in terms of age, gender duration of AF, NYHA class, LA size, PASP. The patients in both the grps who remained in AF were cardioverted at the end of 1 week and 8 weeks and those who did not convert to normal sinus rhythum [NSR] were continued on amiodarone. In both the groups there were 2 subgroups-one subgroup underwent biatrial. Maze [BA] and the other only left atrial maze [LA].

Observations

Within each group, there was no statistically significant difference in the outcome of the 2 subgroups. It was observed that 63.3% of patients converted to NSR at the termination of cardiopulmonary bypass [CPB] in grpA and 46.5% in grp. B. At the time of discharge 82.7% were in NSR in grp.A and 51.7% in grp. B. At the end of a follow up period of 11 months, 82.7% of patients in grp. A and 53.5% of patients in grp. B were restored to NSR.

Conclusions

Perioperative amiodarone improves the success of modified maze procedure in restoring patients to sinus rhythum. Less extensive procedures like LA maze are also effective in restoring patients to NSR with the advantage of further reducing the CPB time.

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Authors and Affiliations

  1. Dr PK Sen Department of Cardiovascular & Thoracic Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra

    Mohammed Ali MS, Susheel Kumar MS, Sandeep Agrawala M.Ch., Sanjeev Kumar Jadhav M.Ch., Jayant Vasant Khandekar M.Ch., Nandkishore Babulal Agrawal M.Ch., Jagdishchandra Mahadeo Sinai Khandeparker M.Ch. &  Anil Madhav Patwardhan M.Ch. (Head)

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  1. Mohammed Ali MS
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  2. Susheel Kumar MS
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  3. Sandeep Agrawala M.Ch.
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  4. Sanjeev Kumar Jadhav M.Ch.
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  6. Nandkishore Babulal Agrawal M.Ch.
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Ali, M., Kumar, S., Agrawala, S. et al. Perioperative use of amiodarone in radiofrequency modified maze procedure for chronic atrial fibrillation. Indian J Thorac Cardiovasc Surg 21, 18–23 (2005). https://doi.org/10.1007/s12055-005-0065-8

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  • DOI: https://doi.org/10.1007/s12055-005-0065-8

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