The comparison between the efficiency of different anti-arrhythmic agents in preventing postoperative atrial fibrillation after open heart surgery
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Objective: Atrial fibrillation (AF) is one of the most frequent complications that may occur after open-heart surgery. Clinical reports regarding comparison of different anti-arrhythmic agent's usage to maintain,sinus rhythm after open-heart surgery are not conclusive. We examined the effects of different anti-arrhythmic agents administration before operation on postoperative AF incidence, duration of hospitalization and complications. Methods: Overall, 180 patients (130 men and 50 women, mean age 58.13 +/- 11.71 years) who were candidates for open-heart surgery, were included in this prospective, single-blind study. All patients divided into five different groups. All anti-arrhythmic drugs were administered approximately 7 days before the operation. Propafenone was given to Group 1 (G1); sotalol to Group 2 (G2); amiodarone to Group 3 (G3) and diltiazem to Group 4 IN) at doses of 300 mg/day, 80 mg/day, 400 mg/day and 180 mg/day orally respectively. The fifth group (G5) did not receive any of anti-arrhythmic drugs. The medication was continued for ten days postoperatively. Statistical analysis was performed using Chi-Square and one-way ANOVA tests. Results: Atrial fibrillation developed during postoperative period in 18.1% patients in G1, 9.1% patients in G2, 16.2% patients in G3, 28.6% patients in G4 and 38.1 % patients in G5. The prevalence of postoperative AF was significantly higher in G5 as compared with other groups (p=0.026). There were significant differences across groups in duration of hospitalization (p=0.033), with shortest mean duration of hospitalization in G2 (8.9 +/- 2.7 days). Conclusion: Any anti-arrhythmic agent started 7 days before the operation and continued for 10 days, may reduce the prevalence of postoperative AF, morbidity and duration of hospitalization. However, we found that sotalol and amiodarone were more effective than other anti-arrhythmic agents in our patient population.