2003
DOI: 10.1161/01.cir.0000087445.59819.6f
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Intravenous Plus Oral Amiodarone, Atrial Septal Pacing, or Both Strategies to Prevent Post-Cardiothoracic Surgery Atrial Fibrillation: The Atrial Fibrillation Suppression Trial II (AFIST II)

Abstract: 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.… Show more

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Cited by 76 publications
(82 citation statements)
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“…The HRV was higher in the AFP maintenance group than the control group in the AFIST-III study, suggesting that parasympathetic tone was enhanced. It is possible that the use of prophylactic beta blockade and amiodarone in the AFIST-III study attenuated postoperative sympathetic dominance, so the elevated parasympathetic activity with AFP maintenance in POAF was muted (13,14).…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…The HRV was higher in the AFP maintenance group than the control group in the AFIST-III study, suggesting that parasympathetic tone was enhanced. It is possible that the use of prophylactic beta blockade and amiodarone in the AFIST-III study attenuated postoperative sympathetic dominance, so the elevated parasympathetic activity with AFP maintenance in POAF was muted (13,14).…”
Section: Discussionmentioning
confidence: 99%
“…We had a high and similar use of beta blockade in both groups, so the benefits of AFP retention might have been attenuated by the sympathetic blockade. Although this might reduce the internal validity somewhat, it enhances the external validity, because beta-blockers are standard-of-care prophylactic drugs in CABG surgery (13,14). It was important to discern the benefits in addition to standard of care.…”
mentioning
confidence: 99%
“…Although most would agree that the highrisk group should receive prophylaxis either before or immediately following surgery and that the low-risk group should not, for intermediate-risk patients cost-tobenefit analyses for potential prevention or therapeutic strategies would provide evidence-based data on which strategy to pursue to minimize drug related adverse events and costs. Because of the multifactorial etiology of postoperative AF and the high breakthrough rate of AF despite single-drug prophylaxis (27), we speculate that a potential strategy for AF prevention with the use of prediction rules could be that intermediate-risk patients receive a combination of antiarrhythmic drugs with differing sites of action and high-risk patients receive similar drug combinations plus prophylactic pacing as prophylaxis, for example (28).…”
Section: Discussionmentioning
confidence: 99%
“…In the atrial fibrillation suppression trial II, 160 patients were randomized to amiodarone or placebo following cardiac surgery, with approximately 1 g of amiodarone given intravenously for the first 24 hours then 600 mg twice daily orally for 4 days. 108 Overall, 80% of patients took concomitant β-blockers and the postoperative incidence of AF was reduced from 39% to 22% by amiodarone, with a reduction in symptomatic AF from 21% to 7%.…”
Section: Medications For Maintenance Of Sr During Proceduresmentioning
confidence: 94%