The Role of Amiodarone in the Prevention of Postoperative Atrial Fibrillation After Surgical Myocardial Revascularization.

Abstract

Background: Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, increasing morbidity, ICU stay, dialysis need, hospitalization length, and costs. Despite prophylactic strategies, POAF incidence remains high, especially in moderate and high risk patients.

Objective: To assess the effect of amiodarone on POAF incidence and onset timing in moderate and high risk patients.

Methods: This prospective observational study included 454 patients undergoing elective coronary artery bypass grafting (CABG). Risk stratification of patients was based on the McSPI AFRisk Index, compared with the POAF Score and CHA2DS2-VASc Score. Moderate and high risk patients received amiodarone in combination with beta blockers (Amiodarone group), while low risk patients received beta blockers only. The primary outcome was POAF incidence, analyzed via Kaplan-Meier and Cox regression. Secondary analysis compared POAF rates between groups using the χ2 test.

Results: POAF occurred in 5.95% of the Amiodarone group versus 9.25% in the beta blocker group (overall incidence: 15.2%). The relative risk reduction was 27% (RR = 0.27, 95% CI = 0.105-0.689, p = 0.006). POAF incidence was significantly lower in the Amiodarone group (p = 0.008, χ2 test). Kaplan-Meier analysis showed delayed POAF onset in the Amiodarone group (median: 48h vs. 33h, p = 0.0007). Cox regression confirmed a 73% lower risk of early POAF (HR = 0.27, 95% CI = 0.105-0.689, p = 0.006).

Conclusion: Amiodarone combined with beta blockers reduces POAF incidence and delays its onset after CABG. Keywords: POAF, CABG, amiodarone, risk stratification. Keywords: Body Dysmorphia, PCOS patients, prevalence.