WASHINGTON, DC—Prophylaxis with intravenous (IV) amiodarone lowered the incidence of atrial fibrillation (AF) after esophagectomy but was associated with several adverse effects, including hypotension, bradycardia, and QT interval prolongation, according to findings from a retrospective study presented at the ACC.17 Scientific Session.

To date, there has not been much study around prophylactic methods to prevent AF following esophagectomy. James Tisdale, PharmD, from Purdue University, and coauthors set out to determine the safety and efficacy of IV amiodarone for the prevention of AF post-esophagectomy. The retrospective cohort study included 254 patients undergoing esophagectomy who were matched 1:1 based on a propensity score including age (±5 years), gender, surgical approach, and history of chronic obstructive pulmonary disease (COPD). 

The patients were divided into the prophylactic IV amiodarone group (n=127) or no prophylaxis (control; n=127). The prophylactic group received amiodarone 43.75mg/hr via continuous IV infusion over 96 hours (total dose 4,200mg) started at the time of anesthesia induction.

Results from the analysis showed a significantly lower incidence of AF among patients in the amiodarone group vs. the control group (15.7% vs. 28.3%; P=0.03). “There were no significant differences between the amiodarone group and the control group in median post-operative length of hospital stay or in the incidence of in-hospital mortality,” added Dr. Tisdale. Median length of stay was 10 days in the amiodarone group vs. 11 days in the control group (P=0.24). There were 3 in-hospital deaths in the amiodarone group compared to 2 deaths in the control group (P=0.93).

Moreover, there was a significantly higher incidence of adverse effects in the amiodarone group vs. the control group regarding hypotension requiring treatment (41.7% vs. 25.2%; P=0.03), bradycardia (7.9% vs. 0.8%; P=0.04), and QT interval prolongation (9.4% vs. 0.9%; P=0.03).