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J Am Heart Assoc. 2019 Aug 6;8(15):e009892. doi: 10.1161/JAHA.118.009892. Epub 2019 Aug 5.

Use and Outcomes Associated With Perioperative Amiodarone in Cardiac Surgery.

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Section of Electrophysiology, Samuel and Jean Frankel Cardiovascular Center University of Michigan Ann Arbor MI.
Institute for Healthcare Delivery and Population Science University of Massachusetts Medical School-Baystate Springfield MA.
School of Public Health and Health Sciences University of Massachusetts Amherst MA.
Department of Medicine University of Massachusetts Medical School-Baystate Springfield MA.
Division of Cardiology University of Massachusetts Medical School-Baystate Springfield MA.
Department of Quantitative and Population Health Sciences University of Massachusetts Medical School Worcester MA.


Background In randomized controlled trials, perioperative administration of amiodarone has been shown to reduce the incidence of postoperative atrial arrhythmias and length of stay (LOS) among patients undergoing coronary bypass surgery. However, little is known about the use or effectiveness of perioperative amiodarone in routine clinical practice. Methods and Results We studied patients ≥18 years old without a previous history of atrial or ventricular arrhythmias who underwent elective coronary bypass surgery between 2013 and 2014 within a network of 235 US hospitals. Perioperative amiodarone was defined as receipt of amiodarone either on the day of or the day preceding surgery. We used covariate-adjusted modeling and instrumental variable methods to examine the association between receipt of amiodarone and the development of atrial arrhythmias, in-hospital mortality, readmission, LOS, and cost. Of 12 758 patients, 2195 (17.2%) received perioperative amiodarone, 3330 (26.1%) developed atrial arrhythmias postoperatively, and the average LOS was 6.4 days (±2.6 days). Instrumental variable analysis showed that receipt of perioperative amiodarone was associated with lower risk of atrial arrhythmias (risk difference -11 percentage points, 95% CI -19 to -4 percentage points; P=0.002) and a shorter LOS (-0.7 day, 95% CI -1.39 to -0.01 days; P=0.048). There was no association between receipt of perioperative amiodarone and in-hospital mortality, cost, or readmission. Conclusions Among patients undergoing coronary bypass surgery without previous arrhythmias, perioperative amiodarone is associated with a lower risk of atrial arrhythmias and shorter LOS. These findings are consistent with previous randomized trials and lend support to current guideline recommendations.


amiodarone; atrial fibrillation arrhythmia; coronary artery bypass graft surgery; heart valve surgery; postoperative complication arrhythmia

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