Diltiazem Prophylaxis for the Prevention of Atrial Fibrillation in Patients Undergoing Thoracoabdominal Esophagectomy: A Retrospective Cohort Study

Abstract

Background Atrial fibrillation (AF) represents the most frequent arrhythmic disorder after thoracoabdominal esophageal resection and is associated with a significant increase in perioperative morbidity and mortality.Methods In this retrospective cohort study, 167 patients who underwent thoracoabdominal esophagectomy at a large university hospital were assessed. We compared patients who received a 14-day postoperative course of diltiazem with a control group of patients who did not undergo diltiazem prophylaxis. Diltiazem therapy started immediately upon admission to the intensive care unit (ICU) with a loading dose of 0.25 mg/kg bodyweight (i.v.) followed by continuous infusion (0.1 mg/kg bodyweight/h) for 40-48 h. Oral administration (Dilzem Ò 180 mg uno retard, once a day) was started on postoperative day 3. Results A total of 117 patients were assessed. Twelve (10.3%) of all patients developed postoperative new-onset atrial fibrillation in the first 30 days after surgical intervention. Prevalence of new-onset AF showed no significant differences between the diltiazem group and control group (p = 0.74). The prevalence of bradycardia (14.7% vs. 3.6%; p = 0.03) and dose of norepinephrine required (0.09 vs. 0.04 lg/kg bodyweight/min; p = 0.04) were higher in the diltiazem group. There were no significant differences between the groups for the median postoperative duration of hospital/ICU stay or mortality. Conclusions A prophylactic 14-day postoperative course of diltiazem was not associated with a reduction in newonset AF or 30-day mortality following thoracoabdominal esophagectomy. Prophylactic diltiazem therapy was associated with drug-related adverse effects such as bradycardia and increased requirement of norepinephrine. German Clinical Trial Registration Number: DKRS00016631.

Effectiveness of pharmacological cardioversion of new-onset atrial fibrillation during thoracic surgery operations: a single-centre experience

“…Prophylactic amiodarone could lower incidence of postoperative AF in patients undergoing pulmonary resection [ 3 ], as well as in patients undergoing esophagectomy [ 4 ]. Similar findings have been reported with other pharmacological conversion agents, including diltiazem [ 5 ] and metoprolol [ 6 ]. The objective of the current study was to examine whether intraoperative use of pharmacological conversion in new AF patients with general thoracic operations could help to restore sinus rhythm.…”

“…Most notably, newonset AF during surgery is primarily due to mechanical stimulation of atria and pulmonary veins and the autonomic nerves, and thus is less likely to respond to drug treatments. In contrast, prophylactic use of antiarrhythmic drugs (e.g., amiodarone, diltiazem, and metoprolol) has been shown to be effective for postoperative AF [4][5][6].…”

Atrial Fibrillation after Lung Cancer Surgery: Prediction, Prevention and Anticoagulation Management

“…Hochreiter et al, in 2020, found that diltiazem did not reduce the incidence of POAF following thoracoabdominal esophagectomy. At the same time, its use was associated with several side effects [67]. Lederer et al, in a very recent study, showed that diltiazem prophylaxis was not useful in reducing POAF incidence after thoracoscopic lobectomy [68].…”

Navigating the Incidence of Postoperative Arrhythmia and Hospitalization Length: The Role of Amiodarone and Other Antiarrhythmics in Prophylaxis

“…Unfortunately, a multitude of shortcomings plague this topic in that the studies focused only on very specific cardiac surgeries such as CABG, and the arrhythmias studied were limited to specific arrhythmias only, namely AFib [77]. Another condition that holds potential is the cohort of patients given prophylactic amiodarone combined with a non-antiarrhythmic.…”