Effect of Low-Dose Amiodarone and Magnesium Combination on Atrial Fibrillation After Coronary Artery Surgery

Abstract

Combined prophylactic therapy with amiodarone and MgSO(4) at the early postoperative period without a maintenance phase is an effective, simple, well-tolerated, and possibly cost-effective regimen to prevent POAF in normomagnesemic, high-risk patients.

Prophylactic Intravenous Magnesium Sulphate in Addition to Oral β-Blockade Does Not Prevent Atrial Arrhythmias After Coronary Artery or Valvular Heart Surgery

“…10,13,15,17,24 -26 In addition, newer randomized studies published since 2002 have had conflicting outcomes (some positive, 27,28 and others negative, 29,30 ). There are 4 potential reasons for these differing outcomes, including: (1) the potential for ␤ error secondary to small sample sizes; (2) differing definitions of atrial fibrillation; (3) differing doses of MgSO 4 administered; and (4) differing use of concomitant ␤-blockade.…”

Magnesium and Cardiac Surgery in the Critical Care Setting

“…This reduces the need for prolonged use of these potent agents, thus decreasing their side effects and costs (Cagli et al 2006). However, the use of Mg supplementation may not offer any additive effect to perioperative beta-blockers in preventing AF (Wu et al 2013).…”

Amiodarone Use to Prevent Postoperative Atrial Fibrillation After Cardiac Surgery

“…The preoperative factors are advanced age greater than 65 years, male sex, hypertension, diabetes mellitus, history of AF, postoperative withdrawal of "-blockers, impaired cardiac function (ejection fraction G50%), chronic obstructive pulmonary disease, chronic renal failure, and electrolyte imbalance. 4 Advanced age is a significant risk factor, and with every decade of age, POAF increases by 75%. 16 The authors explain that atrial dilation, fibrosis, and lipid deposits increase with age along with nonuniform anisotropic conduction.…”

“…Prolonged aortic cross-clamp time (945 minutes) also results in atrial ischemia. 4 Reperfusion, myocardial ischemia, and cardioplegia are included in intraoperative factors that increase the risk of POAF. The postoperative factors are hemodynamic instability, inotropic support, extended ventilation (924 hours), and instrumentations such intraoperative aortic balloon pump.…”

“…3 Although POAF is common, it has shown an increase in morbidity, mortality, length of hospital stay, and health care cost. 4 A meta-analysis done of 14 amiodarone trials revealed that length of stay was reduced (95% confidence interval, j0.92 to j0.29) in this population. 5 There are many known causes and precursors for atrial fibrillation (AF).…”