Amiodarone prophylaxis for atrial fibrillation after cardiac surgery

Meta-analysis of dose response and timing of initiation

Mitchell S. Buckley, Paul E. Nolan, Marion K Slack, James E. Tisdale, Daniel E. Hilleman, Jack G. Copeland

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Study Objective. To investigate a possible dose-response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre- or postoperative initiation of amiodarone is superior. Design. Meta-analysis of randomized controlled trials. Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English-language reports published between 1966 and December 2005. Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose-categorized as low (< 3000 mg), medium (3000-5000 mg), or high (> 5000 mg)-and preoperative versus postoperative initiation were aggregated by using meta-analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p<0.001). Although the odds of developing atrial fibrillation appeared to be somewhat higher in the low-dose group, no significant differences were noted in the odds ratios (ORs) of developing atrial fibrillation among the low-, medium-, and high-dose groups: OR 0.58, 95% confidence interval (CI) 0.44-0.77; OR 0.45, 95% CI 0.30-0.69; and OR 0.44, 95% CI 0.33-0.58; respectively (p=0.238). In addition, the ORs for atrial fibrillation development associated with preoperative and postoperative initiation of amiodarone were not significantly different (OR 0.50, 95% CI 0.39-0.63; and OR 0.48, 95% CI 0.37-0.63; respectively, p=0.862). Conclusion. Total amiodarone doses of 3000 mg or higher may be more effective than lower doses in reducing the rate of postoperative atrial fibrillation after cardiac surgery. Preoperative initiation of amiodarone appears to be unnecessary. These findings require confirmation in prospective, randomized trials.

Original languageEnglish (US)
Pages (from-to)360-368
Number of pages9
JournalPharmacotherapy
Volume27
Issue number3
DOIs
StatePublished - Mar 2007

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Amiodarone
Atrial Fibrillation
Thoracic Surgery
Meta-Analysis
Odds Ratio
Confidence Intervals
Randomized Controlled Trials
Information Storage and Retrieval
Incidence
MEDLINE
Language
Placebos
Databases

Keywords

  • Amiodarone
  • Atrial fibrillation
  • Cardiac surgery
  • Meta-analysis
  • Prophylaxis

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Amiodarone prophylaxis for atrial fibrillation after cardiac surgery : Meta-analysis of dose response and timing of initiation. / Buckley, Mitchell S.; Nolan, Paul E.; Slack, Marion K; Tisdale, James E.; Hilleman, Daniel E.; Copeland, Jack G.

In: Pharmacotherapy, Vol. 27, No. 3, 03.2007, p. 360-368.

Research output: Contribution to journalArticle

Buckley, Mitchell S. ; Nolan, Paul E. ; Slack, Marion K ; Tisdale, James E. ; Hilleman, Daniel E. ; Copeland, Jack G. / Amiodarone prophylaxis for atrial fibrillation after cardiac surgery : Meta-analysis of dose response and timing of initiation. In: Pharmacotherapy. 2007 ; Vol. 27, No. 3. pp. 360-368.
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abstract = "Study Objective. To investigate a possible dose-response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre- or postoperative initiation of amiodarone is superior. Design. Meta-analysis of randomized controlled trials. Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English-language reports published between 1966 and December 2005. Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose-categorized as low (< 3000 mg), medium (3000-5000 mg), or high (> 5000 mg)-and preoperative versus postoperative initiation were aggregated by using meta-analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p<0.001). Although the odds of developing atrial fibrillation appeared to be somewhat higher in the low-dose group, no significant differences were noted in the odds ratios (ORs) of developing atrial fibrillation among the low-, medium-, and high-dose groups: OR 0.58, 95{\%} confidence interval (CI) 0.44-0.77; OR 0.45, 95{\%} CI 0.30-0.69; and OR 0.44, 95{\%} CI 0.33-0.58; respectively (p=0.238). In addition, the ORs for atrial fibrillation development associated with preoperative and postoperative initiation of amiodarone were not significantly different (OR 0.50, 95{\%} CI 0.39-0.63; and OR 0.48, 95{\%} CI 0.37-0.63; respectively, p=0.862). Conclusion. Total amiodarone doses of 3000 mg or higher may be more effective than lower doses in reducing the rate of postoperative atrial fibrillation after cardiac surgery. Preoperative initiation of amiodarone appears to be unnecessary. These findings require confirmation in prospective, randomized trials.",
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AU - Buckley, Mitchell S.

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AU - Slack, Marion K

AU - Tisdale, James E.

AU - Hilleman, Daniel E.

AU - Copeland, Jack G.

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N2 - Study Objective. To investigate a possible dose-response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre- or postoperative initiation of amiodarone is superior. Design. Meta-analysis of randomized controlled trials. Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English-language reports published between 1966 and December 2005. Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose-categorized as low (< 3000 mg), medium (3000-5000 mg), or high (> 5000 mg)-and preoperative versus postoperative initiation were aggregated by using meta-analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p<0.001). Although the odds of developing atrial fibrillation appeared to be somewhat higher in the low-dose group, no significant differences were noted in the odds ratios (ORs) of developing atrial fibrillation among the low-, medium-, and high-dose groups: OR 0.58, 95% confidence interval (CI) 0.44-0.77; OR 0.45, 95% CI 0.30-0.69; and OR 0.44, 95% CI 0.33-0.58; respectively (p=0.238). In addition, the ORs for atrial fibrillation development associated with preoperative and postoperative initiation of amiodarone were not significantly different (OR 0.50, 95% CI 0.39-0.63; and OR 0.48, 95% CI 0.37-0.63; respectively, p=0.862). Conclusion. Total amiodarone doses of 3000 mg or higher may be more effective than lower doses in reducing the rate of postoperative atrial fibrillation after cardiac surgery. Preoperative initiation of amiodarone appears to be unnecessary. These findings require confirmation in prospective, randomized trials.

AB - Study Objective. To investigate a possible dose-response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre- or postoperative initiation of amiodarone is superior. Design. Meta-analysis of randomized controlled trials. Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English-language reports published between 1966 and December 2005. Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose-categorized as low (< 3000 mg), medium (3000-5000 mg), or high (> 5000 mg)-and preoperative versus postoperative initiation were aggregated by using meta-analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p<0.001). Although the odds of developing atrial fibrillation appeared to be somewhat higher in the low-dose group, no significant differences were noted in the odds ratios (ORs) of developing atrial fibrillation among the low-, medium-, and high-dose groups: OR 0.58, 95% confidence interval (CI) 0.44-0.77; OR 0.45, 95% CI 0.30-0.69; and OR 0.44, 95% CI 0.33-0.58; respectively (p=0.238). In addition, the ORs for atrial fibrillation development associated with preoperative and postoperative initiation of amiodarone were not significantly different (OR 0.50, 95% CI 0.39-0.63; and OR 0.48, 95% CI 0.37-0.63; respectively, p=0.862). Conclusion. Total amiodarone doses of 3000 mg or higher may be more effective than lower doses in reducing the rate of postoperative atrial fibrillation after cardiac surgery. Preoperative initiation of amiodarone appears to be unnecessary. These findings require confirmation in prospective, randomized trials.

KW - Amiodarone

KW - Atrial fibrillation

KW - Cardiac surgery

KW - Meta-analysis

KW - Prophylaxis

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