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Eur J Cardiothorac Surg 2004;25:224-230
© 2004 Elsevier Science NL

Supraventricular tachyarrythmia prophylaxis after coronary artery surgery in chronic obstructive pulmonary disease patients (early amiodarone prophylaxis trial)

^a GATA Cardiovascular Surgery Department, Gülhane Military Medical Academy, Yazanlar sokak No. 31/11, Asagi Ayranci, Ankara 06540, Turkey
^b Department of Public Health and Epidemiology, Etlik, Ankara, Turkey

Received 19 July 2003; received in revised form 30 October 2003; accepted 11 November 2003.

^* Corresponding author. Tel.: +90-312-468-1773; fax: +90-312-232-3038
e-mail: ekural{at}gata.edu.tr

Objective: Supraventricular tachyarrhythmias (SVT) is common after coronary artery bypass grafting in chronic obstructive pulmonary disease (COPD). Preoperative FEV₁ is the major predetermining factor of mortality, morbidity and SVT. Methods: Patients were divided into two groups according to their preoperative FEV₁ values. FEV₁ is <75% of predicted value in group 1 (no. 200), and 75% of predicted value in group 2 (no. 100). Group 1 is divided into two subgroups. SVT prophylaxis was not done in A subgroup (no. 100) whereas arrhythmia prophylaxis was done with amiodarone in all B subgroups (no. 100) in the early postoperative period. Results: Atrial fibrillation developed in 28 patients in group 1A, whereas it developed in 12 in group 1B (P=0.005). Atrial flutter developed in 10 patients in group 1A but in 3 patients in group 1B (P=0.045). Multifocal atrial tachycardia developed in 13 patients in group 1A and in 4 in group 1B (P=0.022). Multivariate analysis identified ejection fraction (P<0.002, odds ratio (OR) 0.93), inotropy requirement (P<0.001, OR 3.98) amiodarone (P<0.001, OR 0.18), and FEV₁<75% of predicted value (P<0.048, OR 1.84) as predictor of SVT. There were statistically significant differences between A and B subgroups of group 1 for hospital (P<0.001) and intensive care unit (ICU) stay (P<0.001). There was also statistically significant difference between groups 1A and 2 comparison for ICU (P<0.001; 6.4±3.4 versus 1.4±0.6 days) and hospital stay (P<0.001; 17.6±8.2 versus 6.9±0.6 days). Conclusions: Early prophylactic amiodarone not only significantly reduces SVT but also reduces SVT-related hospital and ICU stay. We strongly recommend prophylactic early use of amiodarone in COPD patients.

Key Words: Amiadarone • Supraventricular tachycardia • Coronary artery bypass

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