Comparison of Amiodarone Loading Dosage in the Treatment of Postoperative Atrial Fibrillation: High Versus Standard Dose Treatment

Ersin Sarıçam; Arslan Öcal; Murat Doğan İşcanlı; Engin Bozkurt; Erdoğan İlkay; Ömer Faruk Cantekin

doi:10.2174/0115701611259127231208051249

ISSN: 1570-1611
E-ISSN: 1875-6212

Comparison of Amiodarone Loading Dosage in the Treatment of Postoperative Atrial Fibrillation: High Versus Standard Dose Treatment
Authors: Ersin Sarıçam¹, Arslan Öcal², Murat Doğan İşcanlı³, Engin Bozkurt⁴, Erdoğan İlkay⁵ and Ömer Faruk Cantekin⁶
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Affiliations: ¹ Cardiology Clinic, Medicana International Ankara Hospital, Atilim University, Ankara, Turkey ; ² Cardiology Clinic, Saglik Bilimleri University, Gülhane Eğitim ve Araştırma Hastanesi, Ankara, Turkey ; ³ Emergency Department, Medicana International Ankara Hospital, Atilim University, Ankara, Turkey ; ⁴ Cardiology Clinic, Medicana International Ankara Hospital, Ankara, Turkey ; ⁵ Cardiology Clinic, Medicana International Ankara Hospital, Cardiology Clinic, Ankara, Turkey ; ⁶ Department of Social Work, Faculty of Health Sciences, Gazi University, Ankara, Turkey
Source: Current Vascular Pharmacology, Volume 22, Issue 6, Nov 2024, p. 386 - 390
DOI: https://doi.org/10.2174/0115701611259127231208051249
- Received: 22 May 2023
- Accepted: 15 Nov 2023
- Available online: 29 Aug 2024

Abstract

Background

Postoperative atrial fibrillation (POAF) is associated with poor outcomes, including hemodynamic instability, stroke, myocardial infarction, and death. In hemodynamic stable patients, the rhythm-control strategy is more advantageous than rate control. Current standard intravenous amiodarone administration has limited success and a delayed effect; the acute success rate is 44% (8-12 h to several days).

Purpose

The aim of this study was to evaluate the effectiveness of higher amiodarone loading dosage to restore sinus rhythm in patients with POAF after noncardiac surgery.

Methods

This is a prospective, randomized, controlled single-center study. The study included 39 patients with POAF, divided into group I (n=27) (intravenous 600 mg amiodarone loading dosage over 2 h and infusion of 50 mg/h over a 24-h period) and group II (n=12) (standard protocol; 300 mg of bolus intravenously in 30 min and infusion of 50 mg/h over a 24-h period). The primary endpoint of the study was a restoration of sinus rhythm at the 24th hour.

Results

Baseline clinical, laboratory and echocardiographic characteristics of both groups were similar. The patients with higher loading amiodarone dosage had earlier restoration of sinus rhythm (2.38 ± 1.41 vs 8.66 ± 2.87 h, respectively; p=0.015). There was no significant difference in achieving sinus rhythm at the 24th hour between both groups.

Conclusion

Higher loading amiodarone dosage increased early conversions to sinus rhythm compared with standard amiodarone protocol in patients with POAF.

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References

HindricksG. PotparaT. DagresN. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).Eur. Heart J.202142537349810.1093/eurheartj/ehaa612 32860505
[Google Scholar]
ConenD. Alonso-CoelloP. DouketisJ. Risk of stroke and other adverse outcomes in patients with perioperative atrial fibrillation 1 year after non-cardiac surgery.Eur. Heart J.202041564565110.1093/eurheartj/ehz431 31237939
[Google Scholar]
AlTurkiA. MarafiM. ProiettiR. Major adverse cardiovascular events associated with postoperative atrial fibrillation after noncardiac surgery: a systematic review and meta-analysis.Circ. Arrhythm. Electrophysiol.2020131e00743710.1161/CIRCEP.119.007437 31944855
[Google Scholar]
GillinovA.M. BagiellaE. MoskowitzA.J. Rate control versus rhythm control for atrial fibrillation after cardiac surgery.N. Engl. J. Med.2016374201911192110.1056/NEJMoa1602002 27043047
[Google Scholar]
KaramnovS. MuehlschlegelJ.D. Inflammatory responses to surgery and postoperative atrial fibrillation.Anesthesiology2022136687787910.1097/ALN.0000000000004233 35482968
[Google Scholar]
BessissowA. KhanJ. DevereauxP.J. Alvarez-GarciaJ. Alonso-CoelloP. Postoperative atrial fibrillation in non‐cardiac and cardiac surgery: An overview.J. Thromb. Haemost.201513Suppl. 1S304S31210.1111/jth.12974 26149040
[Google Scholar]
AlbiniA. MalavasiV.L. VitoloM. Long-term outcomes of postoperative atrial fibrillation following non cardiac surgery: A systematic review and metanalysis.Eur. J. Intern. Med.202185273310.1016/j.ejim.2020.12.018 33402281
[Google Scholar]
LinM.H. KamelH. SingerD.E. WuY.L. LeeM. OvbiageleB. Perioperative/postoperative atrial fibrillation and risk of subsequent stroke and/or mortality.Stroke20195061364137110.1161/STROKEAHA.118.023921 31043148
[Google Scholar]
HalvorsenS. MehilliJ. CasseseS. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery.Eur. Heart J.202243393826392410.1093/eurheartj/ehac270 36017553
[Google Scholar]
ChevalierP. Durand-DubiefA. BurriH. CucheratM. KirkorianG. TouboulP. Amiodarone versus placebo and class ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis.J. Am. Coll. Cardiol.200341225526210.1016/S0735‑1097(02)02705‑5 12535819
[Google Scholar]
GalveE. RiusT. BallesterR. Intravenous amiodarone in treatment of recent-onset atrial fibrillation: Results of a randomized, controlled study.J. Am. Coll. Cardiol.19962751079108210.1016/0735‑1097(95)00595‑1 8609324
[Google Scholar]
Martínez-MarcosF.J. García-GarmendiaJ.L. Ortega-CarpioA. Fernández-GómezJ.M. SantosJ.M. CamachoC. Comparison of intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm.Am. J. Cardiol.200086995095310.1016/S0002‑9149(00)01128‑0 11053705
[Google Scholar]
GaudinoM. Di FrancoA. RongL.Q. PicciniJ. MackM. Postoperative atrial fibrillation: From mechanisms to treatment.Eur. Heart J.202344121020103910.1093/eurheartj/ehad019 36721960
[Google Scholar]
DobrevD. AguilarM. HeijmanJ. GuichardJ.B. NattelS. Postoperative atrial fibrillation: Mechanisms, manifestations and management.Nat. Rev. Cardiol.201916741743610.1038/s41569‑019‑0166‑5 30792496
[Google Scholar]
DucasR. AriyarajahV. Atrial fibrillation in patients with ischemic and non-ischemic left ventricular dysfunction.J. Atr. Fibrillation201355535 28496804
[Google Scholar]
KochiadakisG. SkalidisE.I. KalebubasM.D. Effect of acute atrial fibrillation on phasic coronary blood flow pattern and flow reserve in humans.Eur. Heart J.200223973474110.1053/euhj.2001.2894 11978000
[Google Scholar]
HeintzK.M. HollenbergS.M. Perioperative cardiac issues: Postoperative arrhythmias.Surg. Clin. North Am.20058561103-1114 [viii].10.1016/j.suc.2005.09.003 16326196
[Google Scholar]
CotterG. BlattA. KaluskiE. Conversion of recent onset paroxysmal atrial fibrillation to normal sinus rhythm: The effect of no treatment and high-dose amiodarone. A randomized, placebo-controlled study.Eur. Heart J.199920241833184210.1053/euhj.1999.1747 10581142
[Google Scholar]
DonovanK.D. PowerB.M. HockingsB.E.F. DobbG.J. LeeK-Y. Intravenous flecainide versus Amiedarone fof recent-onset atrial fibrillation.Am. J. Cardiol.1995751069369710.1016/S0002‑9149(99)80655‑9 7900662
[Google Scholar]
TusethV. JaatunH.J. DicksteinK. Amiodarone infusion in the treatment of acute atrial fibrillation or flutter: high versus low dose treatment.Heart200591796496510.1136/hrt.2004.049171 15958375
[Google Scholar]
JanuaryC.T. WannL.S. CalkinsH. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.J. Am. Coll. Cardiol.201974110413210.1016/j.jacc.2019.01.011 30703431
[Google Scholar]
KaracaglarE. AtarI. OzbiçerS. Amiodarone versus direct current cardioversion in treatment of atrial fibrillation after cardiac surgery.Turk J Clin Lab2019102632[Available from https://dergipark.org.tr/en/pub/tjcl/issue/44073/519537
[Google Scholar]