Prophylactic Oral Amiodarone for the Prevention of Arrhythmias That Begin Early After Revascularization, Valve Replacement, or Repair

Mitchell, L. Brent; Exner, Derek V.; Wyse, D. George; Connolly, Carol J.; Prystai, Gregory D.; Bayes, Alexander J.; Kidd, William T.; Kieser, Teresa M.; Burgess, John J.; Ferland, André; MacAdams, Charles; Maitland, Andrew

doi:10.1001/jama.294.24.3093

Cited by 300 publications

(195 citation statements)

References 44 publications

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“…As shown by several RCTs and meta-analyses [183,184,186], amiodarone is effective for the prophylaxis of AF. The largest RCT reported atrial tachyarrhythmias in 16.1% of amiodarone-treated patients compared with 29.5% of placebo-treated patients (HR 0.52, 95% CI 0.34 0.69), a 13.4% absolute risk reduction [184]. However, amiodarone trials excluded patients with low resting heart rate, second or third degree atrioventricular block, or New York Heart Association (NYHA) class III or IV.…”

Section: S28 Esc/eacts Task Force On Myocardial Revascularization / Ementioning

confidence: 98%

“…b-blockers, sotalol, and amiodarone reduce the risk of post-operative AF [183,184]. There is a wealth of safety and efficacy data, including two recent meta-analyses, supporting the routine use of b-blockers in post-operative cardiac surgical patients to reduce the incidence of post-operative AF (OR 0.36, 95% CI 0.28 0.47) [185,186].…”

Section: S28 Esc/eacts Task Force On Myocardial Revascularization / Ementioning

confidence: 99%

See 1 more Smart Citation

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

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Section: S28 Esc/eacts Task Force On Myocardial Revascularization / Ementioning

confidence: 98%

Section: S28 Esc/eacts Task Force On Myocardial Revascularization / Ementioning

confidence: 99%

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

View full text Add to dashboard Cite

“…The lack of mechanistic cellular insight into the genesis of oxidative AF hampered the development of effective pharmacological therapy to suppress and/or prevent the oxidative AF [11]. For example, beta-blockers [12] and Amiodarone, [13] considered first line preventive drugs against POAF, are only partially effective. Interestingly, both human and animal studies have shown increased atrial CaMKII activity as the molecular signal that couples oxidative stress with AF [10].…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation Initiated by Early Afterdepolarization-Mediated Triggered Activity during Acute Oxidative Stress: Efficacy of Late Sodium Current Blockade

Pezhouman¹,

Cao

Fishbein

et al. 2018

J Hear Health

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Background The mechanism of Atrial Fibrillation (AF) that emerges spontaneously during acute oxidative stress is poorly defined and its drug therapy remains suboptimal. We hypothesized that oxidative activation of Ca-calmodulin dependent protein kinase (CaMKII) promotes Early Afterdepolarization-(EAD)-mediated triggered AF in aged fibrotic atria that is sensitive to late Na current (INa-L) blockade. Method and Results High-resolution voltage optical mapping of the Left and Right Atrial (LA & RA) epicardial surfaces along with microelectrode recordings were performed in isolated-perfused male Fisher 344 rat hearts in Langendorff setting. Aged atria (23–24 months) manifested 10-fold increase in atrial tissue fibrosis compared to young/adult (2–4 months) atria (P<0001. Spontaneous AF arose in 39 out of 41 of the aged atria but in 0 out of 12 young/adult hearts (P<001) during arterial perfusion of with 0.1 mm of hydrogen peroxide (H2O2). Optical Action Potential (AP) activation maps showed that the AF was initiated by a focal mechanism in the LA suggestive of EAD-mediated triggered activity. Cellular AP recordings with glass microelectrodes from the LA epicardial sites showing focal activity confirmed optical AP recordings that the spontaneous AF was initiated by late phase 3 EAD-mediated triggered activity. Inhibition of CaMKII activity with KN-93 (1 μM) (N=6) or its downstream target, the enhanced INa-L with GS-967 (1 μM), a specific blocker of INa-L (N=6), potently suppressed the AF and prevented its initiation when perfused 15 min prior to H2O2 (n=6). Conclusions Increased atrial tissue fibrosis combined with acute oxidative activation of CaMK II Initiate AF by EAD-mediated triggered activity. Specific block of the INa-L with GS-967 effectively suppresses the AF. Drug therapy of oxidative AF in humans with traditional antiarrhythmic drugs remains suboptimal; suppressing INa-L offers a potential new strategy for effective suppression of oxidative human AF that remains suboptimal.

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“…6,7 The largest trial in cardiac surgery patients is the Prophylactic Oral Amiodarone for the Prevention of Arrythmias that Begin Early After Revascularization, (PAPABEAR) Valve Replacement, or Repair study. 7 In this randomized, double-blind, placebo-controlled trial, 601 patients undergoing CABG surgery, valve replacement/repair, or both, were randomized to receive oral amiodarone or placebo, starting 6 days prior to surgery and continuing for 6 days postoperatively. More than half the patients in each treatment group also received preoperative beta-blockers.…”

Section: Introductionmentioning

confidence: 99%

Amiodarone for Atrial Fibrillation Following Cardiac Surgery: Development of Clinical Practice Guidelines at a University Hospital

Khanderia¹,

Wagner²,

Walker³

et al. 2007

Clinical Cardiology

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SummaryAtrial fibrillation (AF) usually develops within the first 72 h following cardiac surgery, and is often selflimiting. Within 48 h of acute onset of symptoms, approximately 50% of patients spontaneously convert to normal sinus rhythm. Thus, the relative risks and benefits of therapy must be carefully considered. The etiology of AF following cardiac surgery is similar to that in nonsurgical patients except that pericardial inflammation and increased adrenergic tone play an increasingly important role. Further, AF after surgery may be associated with transient risk factors that resolve as the patient moves out from surgery, and the condition is less likely to recur compared with AF arising in other circumstances. Immediate heart rate control is important in preventing ischemia, tachycardia-induced cardiomyopathy, and left ventricular dilatation.At our institution, amiodarone is frequently used as a first-line drug for treating AF after cardiac surgery. Inconsistent prescribing practices, variable dosage regimens, and a lack of consensus regarding the appropriate use of amiodarone prompted the need for developing practice guidelines. Multidisciplinary collaboration between the departments of cardiac surgery, pharmacy, and anesthesiology led to the development of a protocol for postoperative AF. We review the clinical evidence from published trials and discuss our guidelines, defining amiodarone use for AF in the cardiac surgery setting.

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Prophylactic Oral Amiodarone for the Prevention of Arrhythmias That Begin Early After Revascularization, Valve Replacement, or Repair

Abstract: Oral amiodarone prophylaxis of atrial tachyarrhythmias after cardiac surgery is effective and may be safe overall and in important patient subgroups. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT00251706.

Cited by 300 publications

References 44 publications

Guidelines on myocardial revascularization

Guidelines on myocardial revascularization

Atrial Fibrillation Initiated by Early Afterdepolarization-Mediated Triggered Activity during Acute Oxidative Stress: Efficacy of Late Sodium Current Blockade

Amiodarone for Atrial Fibrillation Following Cardiac Surgery: Development of Clinical Practice Guidelines at a University Hospital

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