Prophylactic use of Amiodarone in Coronary Artery Bypass Graft Patients with Less Ejection Fraction

Abstract

Background: Dysrhythmias like atrial fibrillation are most common in post-CABG patients, with an incidence of around 40%. Prophylactic amiodarone treatment decreases the occurrence of dysrhythmias in low ejection fraction patients. Some studies have reported that the benefit of giving amiodarone is more in high-risk patients such as those having older age, higher angina class, diabetes, and severe coronary artery disease (CAD). This study aims to determine the role of amiodarone prophylaxis in the prevention of dysrhythmias following CABG in patients with low ejection fractions.

Methodology: In this non-randomized study, we included150 patients who underwent CABG at Multan Institute of Cardiology from Jan-2019 to Aug-2019, having EF ≤35%. In the amiodarone group (N=75), 3 mg/Kg of amiodarone was given through CPB machine after removal of the X-clamp and before weaning from cardiopulmonary bypass. While in the remaining 75 patients, no anti-arrhythmic drug treatment was given during the peri-operative period.  The occurrence of postoperative arrhythmia during the primary hospital stay after surgery was a primary study endpoint.

Results: There was no significant difference between patients' mean age, gender, BMI, and the number of grafts in the amiodarone group 3.9±0.53 and control group 3.04±0.50 (p-value 0.20). The frequency of Post operative Atrial fibrillation (POAF) was significantly different in both groups. In the amiodarone group, 13 (17.3%) patients developed POAF, and in the control group, POAF occurred in 25 (33.3%) patients (p-value 0.024).

Conclusion: Amiodarone prophylaxis significantly lowers the incidence of POAF after CABG in low EF patients.