Amiodarone for prevention of atrial fibrillation following esophagectomy

James E. Tisdale, Heather A. Jaynes, Matthew R. Watson, Andi L. Corya, Changyu Shen, Kenneth Kesler

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Atrial fibrillation (AF) is a common complication after esophagectomy and is associated with symptoms, hemodynamic instability, prolonged hospital stay, and an increased incidence of mortality. Our objective was to determine the efficacy and safety of intravenous amiodarone for prophylaxis of postesophagectomy AF. Methods: In this retrospective cohort study, 309 patients who underwent esophagectomy formed the initial cohort. Following propensity score-matching, 110 patients who received prophylactic amiodarone 43.75 mg/hour via continuous intravenous infusion over 96 hours (total dose, 4200 mg) were matched to a control group of patients who did not undergo amiodarone prophylaxis (n = 110). The propensity score was obtained using a multivariate logistic regression model with amiodarone as the variable and the following covariates: age, sex, surgical approach, history of neoadjuvant chemotherapy and/or radiation, chronic obstructive pulmonary disease, heart failure, cardiovascular disease, alcohol use (>7 drinks/week), preadmission β-blockers discontinued during hospitalization, preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, preoperative use of corticosteroids, postoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, postoperative use of corticosteroids, postoperative use of statins, and preoperative Charlson comorbidity index. Results: The incidence of AF requiring treatment due to rapid ventricular rate and symptoms was lower in the amiodarone group (17 out of 110 [15.5%] vs 32 out of 110 [29.1%]; odds ratio, 0.45; 95% confidence interval, 0.23-0.86; P =.015). There were no significant differences between the groups in median postoperative length of hospital stay, incidence of pulmonary complications, or mortality. The incidences of hypotension requiring treatment (42.7% vs 21.8%; P =.001), bradycardia (8.2% vs 0.0%; P =.002), and corrected QT interval prolongation (10.9% vs 0.0%; P ≤.0001) were significantly higher in the amiodarone group. Conclusions: Prophylactic intravenous amiodarone is associated with a reduction in the incidence of AF following esophagectomy, but is not associated with shorter postoperative length of hospital stay. Intravenous amiodarone for prophylaxis of postesophagectomy AF is associated with hypotension, bradycardia, and corrected QT interval prolongation.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Esophagectomy
Amiodarone
Atrial Fibrillation
Length of Stay
Incidence
Propensity Score
Angiotensin Receptor Antagonists
Bradycardia
Angiotensin-Converting Enzyme Inhibitors
Hypotension
Adrenal Cortex Hormones
Logistic Models
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Mortality
Intravenous Infusions
Chronic Obstructive Pulmonary Disease
Comorbidity
Hospitalization
Cohort Studies
Cardiovascular Diseases

Keywords

  • amiodarone
  • atrial fibrillation
  • esophagectomy
  • propensity score
  • prophylaxis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Amiodarone for prevention of atrial fibrillation following esophagectomy. / Tisdale, James E.; Jaynes, Heather A.; Watson, Matthew R.; Corya, Andi L.; Shen, Changyu; Kesler, Kenneth.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Tisdale, James E. ; Jaynes, Heather A. ; Watson, Matthew R. ; Corya, Andi L. ; Shen, Changyu ; Kesler, Kenneth. / Amiodarone for prevention of atrial fibrillation following esophagectomy. In: Journal of Thoracic and Cardiovascular Surgery. 2019.
@article{32c01154923941cba2ea09109edda7dc,
title = "Amiodarone for prevention of atrial fibrillation following esophagectomy",
abstract = "Objectives: Atrial fibrillation (AF) is a common complication after esophagectomy and is associated with symptoms, hemodynamic instability, prolonged hospital stay, and an increased incidence of mortality. Our objective was to determine the efficacy and safety of intravenous amiodarone for prophylaxis of postesophagectomy AF. Methods: In this retrospective cohort study, 309 patients who underwent esophagectomy formed the initial cohort. Following propensity score-matching, 110 patients who received prophylactic amiodarone 43.75 mg/hour via continuous intravenous infusion over 96 hours (total dose, 4200 mg) were matched to a control group of patients who did not undergo amiodarone prophylaxis (n = 110). The propensity score was obtained using a multivariate logistic regression model with amiodarone as the variable and the following covariates: age, sex, surgical approach, history of neoadjuvant chemotherapy and/or radiation, chronic obstructive pulmonary disease, heart failure, cardiovascular disease, alcohol use (>7 drinks/week), preadmission β-blockers discontinued during hospitalization, preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, preoperative use of corticosteroids, postoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, postoperative use of corticosteroids, postoperative use of statins, and preoperative Charlson comorbidity index. Results: The incidence of AF requiring treatment due to rapid ventricular rate and symptoms was lower in the amiodarone group (17 out of 110 [15.5{\%}] vs 32 out of 110 [29.1{\%}]; odds ratio, 0.45; 95{\%} confidence interval, 0.23-0.86; P =.015). There were no significant differences between the groups in median postoperative length of hospital stay, incidence of pulmonary complications, or mortality. The incidences of hypotension requiring treatment (42.7{\%} vs 21.8{\%}; P =.001), bradycardia (8.2{\%} vs 0.0{\%}; P =.002), and corrected QT interval prolongation (10.9{\%} vs 0.0{\%}; P ≤.0001) were significantly higher in the amiodarone group. Conclusions: Prophylactic intravenous amiodarone is associated with a reduction in the incidence of AF following esophagectomy, but is not associated with shorter postoperative length of hospital stay. Intravenous amiodarone for prophylaxis of postesophagectomy AF is associated with hypotension, bradycardia, and corrected QT interval prolongation.",
keywords = "amiodarone, atrial fibrillation, esophagectomy, propensity score, prophylaxis",
author = "Tisdale, {James E.} and Jaynes, {Heather A.} and Watson, {Matthew R.} and Corya, {Andi L.} and Changyu Shen and Kenneth Kesler",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jtcvs.2019.01.095",
language = "English (US)",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Amiodarone for prevention of atrial fibrillation following esophagectomy

AU - Tisdale, James E.

AU - Jaynes, Heather A.

AU - Watson, Matthew R.

AU - Corya, Andi L.

AU - Shen, Changyu

AU - Kesler, Kenneth

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Atrial fibrillation (AF) is a common complication after esophagectomy and is associated with symptoms, hemodynamic instability, prolonged hospital stay, and an increased incidence of mortality. Our objective was to determine the efficacy and safety of intravenous amiodarone for prophylaxis of postesophagectomy AF. Methods: In this retrospective cohort study, 309 patients who underwent esophagectomy formed the initial cohort. Following propensity score-matching, 110 patients who received prophylactic amiodarone 43.75 mg/hour via continuous intravenous infusion over 96 hours (total dose, 4200 mg) were matched to a control group of patients who did not undergo amiodarone prophylaxis (n = 110). The propensity score was obtained using a multivariate logistic regression model with amiodarone as the variable and the following covariates: age, sex, surgical approach, history of neoadjuvant chemotherapy and/or radiation, chronic obstructive pulmonary disease, heart failure, cardiovascular disease, alcohol use (>7 drinks/week), preadmission β-blockers discontinued during hospitalization, preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, preoperative use of corticosteroids, postoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, postoperative use of corticosteroids, postoperative use of statins, and preoperative Charlson comorbidity index. Results: The incidence of AF requiring treatment due to rapid ventricular rate and symptoms was lower in the amiodarone group (17 out of 110 [15.5%] vs 32 out of 110 [29.1%]; odds ratio, 0.45; 95% confidence interval, 0.23-0.86; P =.015). There were no significant differences between the groups in median postoperative length of hospital stay, incidence of pulmonary complications, or mortality. The incidences of hypotension requiring treatment (42.7% vs 21.8%; P =.001), bradycardia (8.2% vs 0.0%; P =.002), and corrected QT interval prolongation (10.9% vs 0.0%; P ≤.0001) were significantly higher in the amiodarone group. Conclusions: Prophylactic intravenous amiodarone is associated with a reduction in the incidence of AF following esophagectomy, but is not associated with shorter postoperative length of hospital stay. Intravenous amiodarone for prophylaxis of postesophagectomy AF is associated with hypotension, bradycardia, and corrected QT interval prolongation.

AB - Objectives: Atrial fibrillation (AF) is a common complication after esophagectomy and is associated with symptoms, hemodynamic instability, prolonged hospital stay, and an increased incidence of mortality. Our objective was to determine the efficacy and safety of intravenous amiodarone for prophylaxis of postesophagectomy AF. Methods: In this retrospective cohort study, 309 patients who underwent esophagectomy formed the initial cohort. Following propensity score-matching, 110 patients who received prophylactic amiodarone 43.75 mg/hour via continuous intravenous infusion over 96 hours (total dose, 4200 mg) were matched to a control group of patients who did not undergo amiodarone prophylaxis (n = 110). The propensity score was obtained using a multivariate logistic regression model with amiodarone as the variable and the following covariates: age, sex, surgical approach, history of neoadjuvant chemotherapy and/or radiation, chronic obstructive pulmonary disease, heart failure, cardiovascular disease, alcohol use (>7 drinks/week), preadmission β-blockers discontinued during hospitalization, preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, preoperative use of corticosteroids, postoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, postoperative use of corticosteroids, postoperative use of statins, and preoperative Charlson comorbidity index. Results: The incidence of AF requiring treatment due to rapid ventricular rate and symptoms was lower in the amiodarone group (17 out of 110 [15.5%] vs 32 out of 110 [29.1%]; odds ratio, 0.45; 95% confidence interval, 0.23-0.86; P =.015). There were no significant differences between the groups in median postoperative length of hospital stay, incidence of pulmonary complications, or mortality. The incidences of hypotension requiring treatment (42.7% vs 21.8%; P =.001), bradycardia (8.2% vs 0.0%; P =.002), and corrected QT interval prolongation (10.9% vs 0.0%; P ≤.0001) were significantly higher in the amiodarone group. Conclusions: Prophylactic intravenous amiodarone is associated with a reduction in the incidence of AF following esophagectomy, but is not associated with shorter postoperative length of hospital stay. Intravenous amiodarone for prophylaxis of postesophagectomy AF is associated with hypotension, bradycardia, and corrected QT interval prolongation.

KW - amiodarone

KW - atrial fibrillation

KW - esophagectomy

KW - propensity score

KW - prophylaxis

UR - http://www.scopus.com/inward/record.url?scp=85062420425&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062420425&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.01.095

DO - 10.1016/j.jtcvs.2019.01.095

M3 - Article

AN - SCOPUS:85062420425

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

ER -