Background-The effect of a hybrid intravenous and oral prophylactic amiodarone regimen on postcardiothoracic surgery (CTS) atrial fibrillation (AF) is unknown. The impact of active atrial septal pacing on post-CTS AF has not been well characterized. In addition, the effect of using both amiodarone and atrial septal pacing together to prevent atrial fibrillation is unknown. Methods and Results-Patients (nϭ160) were randomized to amiodarone or placebo and then to pacing or no pacing using a 2ϫ2 factorial design. All therapies began within 6 hours post-CTS. Amiodarone was given by intravenous infusion for the first 24 hours (1050 mg total) followed by oral therapy for 4 postoperative days (4800 mg total). Atrial septal pacing was given for 96 hours. Amiodarone reduced the risk of AF by 43% and the risk of symptomatic AF by 68% (Pϭ0.037 and Pϭ0.019) versus placebo. Atrial septal pacing did not reduce AF or symptomatic AF incidence versus no pacing. The risk of post-CTS AF in the patients receiving amiodaroneϩpacing was lower than the placeboϩno pacing and the placeboϩpacing groups (57.9% and 60.5% reductions, Pϭ0.047 and Pϭ0.040, respectively). Conclusions-Amiodarone given as both an intravenous and oral regimen is effective at reducing post-CTS AF but atrial septal pacing is ineffective. Combining amiodarone and pacing is better than placebo with or without pacing but not amiodarone alone.

AngioVac Cannula can be used safely and effectively as an adjunctive method for patients with large lead vegetation.

Although many of the changes in today's health care arena have been beneficial, there continues to be persistent dissatisfaction with the nation's health care delivery system. The provision of outcome-oriented, cost-effective health care is no longer a goal. It is a mandate. To accomplish this mandate, the relationship between the costs, quality and desired outcomes of care, and the processes involved in providing care must be reexamined. This article describes factors stimulating the American Nurses Association to develop nursing-sensitive quality indicators, details development of the National Database for Nursing Quality Indicators (NDNQI), and discusses the implications of nursing-sensitive indicators and NDNQI for nurse administrators. Nursing's quality indicators can be of value in the development of evidence-based health care report cards and can be used to direct change. We must move forward together in claiming the future of nursing through nursing-sensitive quality indicators.

Maintaining the AFP prevents attenuation of parasympathetic tone after CABG but does not reduce POAF or total hospital costs in any appreciable way.