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Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta‐Analysis of Dose Response and Timing of Initiation
Study Objective. To investigate a possible dose‐response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre‐ or postoperative initiation of amiodarone is superior. Design. Meta‐analysis of randomized controlled trials. Data S...
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| Published in: | Pharmacotherapy 2007-03, Vol.27 (3), p.360-368 |
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| container_end_page | 368 |
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| container_title | Pharmacotherapy |
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| creator | Buckley, Mitchell S. Nolan, Paul E. Slack, Marion K. Tisdale, James E. Hilleman, Daniel E. Copeland, Jack G. |
| description | Study Objective. To investigate a possible dose‐response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre‐ or postoperative initiation of amiodarone is superior.
Design. Meta‐analysis of randomized controlled trials.
Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English‐language reports published between 1966 and December 2005.
Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose—categorized as low (< 3000 mg), medium (3000–5000 mg), or high (> 5000 mg)—and preoperative versus postoperative initiation were aggregated by using meta‐analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p |
| doi_str_mv | 10.1592/phco.27.3.360 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69036952</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69036952</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3642-a71a7ea55ca809cf0e6893a722101d08b1d307160e610c2c4d54bfc4649e6eb3</originalsourceid><addsrcrecordid>eNp90DFv1DAYBmALUdGjMLIiL7Dl6s9O7IQtOiit1Iqq3G59cZzWKImDnRNkgp_Ab-SX4Oud1I3Jlv34tf0S8gbYGoqKn08Pxq-5Wou1kOwZWUGpiqwCyJ-TFeNKZYyx8pS8jPEbYxxkzl-QU1ACJOTlivyqB-dbDH609Db46WHp8aeLtPOB1nNw2NML1wTX9zg7P9K6m22gGwytQ0O_7sK9DcsHemNn_Pv7Tz1iv8R03Hf0o4-W3tk4-TFNcGzp1g1uvN_vXY1udo-Br8hJh320r4_jGdlefNpuLrPrL5-vNvV1ZkR6coYKUFksCoMlq0zHrCwrgYpzYNCysoFWMAUyrQMz3ORtkTedyWVeWWkbcUbeH2Kn4L_vbJz14KKx6Vej9buoZcWErAqeYHaAJvgYg-30FNyAYdHA9L5wvS9cc6WFToUn__YYvGsG2z7pY8MJvDsCjAb7LuBoXHxyZVGCyCE5fnA_XG-X_9-qby_rO8G5-AfFPJtX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69036952</pqid></control><display><type>article</type><title>Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta‐Analysis of Dose Response and Timing of Initiation</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Buckley, Mitchell S. ; Nolan, Paul E. ; Slack, Marion K. ; Tisdale, James E. ; Hilleman, Daniel E. ; Copeland, Jack G.</creator><creatorcontrib>Buckley, Mitchell S. ; Nolan, Paul E. ; Slack, Marion K. ; Tisdale, James E. ; Hilleman, Daniel E. ; Copeland, Jack G.</creatorcontrib><description>Study Objective. To investigate a possible dose‐response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre‐ or postoperative initiation of amiodarone is superior.
Design. Meta‐analysis of randomized controlled trials.
Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English‐language reports published between 1966 and December 2005.
Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose—categorized as low (< 3000 mg), medium (3000–5000 mg), or high (> 5000 mg)—and preoperative versus postoperative initiation were aggregated by using meta‐analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p<0.001). Although the odds of developing atrial fibrillation appeared to be somewhat higher in the low‐dose group, no significant differences were noted in the odds ratios (ORs) of developing atrial fibrillation among the low‐, medium‐, and high‐dose groups: OR 0.58, 95% confidence interval (CI) 0.44–0.77; OR 0.45, 95% CI 0.30–0.69; and OR 0.44, 95% CI 0.33–0.58; respectively (p=0.238). In addition, the ORs for atrial fibrillation development associated with preoperative and postoperative initiation of amiodarone were not significantly different (OR 0.50, 95% CI 0.39–0.63; and OR 0.48, 95% CI 0.37–0.63; respectively, p=0.862).
Conclusion. Total amiodarone doses of 3000 mg or higher may be more effective than lower doses in reducing the rate of postoperative atrial fibrillation after cardiac surgery. Preoperative initiation of amiodarone appears to be unnecessary. These findings require confirmation in prospective, randomized trials.</description><identifier>ISSN: 0277-0008</identifier><identifier>EISSN: 1875-9114</identifier><identifier>DOI: 10.1592/phco.27.3.360</identifier><identifier>PMID: 17316148</identifier><identifier>CODEN: PHPYDQ</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>amiodarone ; Amiodarone - administration & dosage ; Amiodarone - therapeutic use ; atrial fibrillation ; Atrial Fibrillation - drug therapy ; Biological and medical sciences ; Cardiac dysrhythmias ; cardiac surgery ; Cardiology. Vascular system ; Heart ; Humans ; Incidence ; Medical sciences ; meta‐analysis ; Pharmacology. Drug treatments ; Postoperative Complications - prevention & control ; Postoperative Period ; Preoperative Care ; prophylaxis ; Thoracic Surgery ; Time Factors ; Vasodilator Agents - administration & dosage ; Vasodilator Agents - therapeutic use</subject><ispartof>Pharmacotherapy, 2007-03, Vol.27 (3), p.360-368</ispartof><rights>2007 Pharmacotherapy Publications Inc.</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3642-a71a7ea55ca809cf0e6893a722101d08b1d307160e610c2c4d54bfc4649e6eb3</citedby><cites>FETCH-LOGICAL-c3642-a71a7ea55ca809cf0e6893a722101d08b1d307160e610c2c4d54bfc4649e6eb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18581341$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17316148$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Buckley, Mitchell S.</creatorcontrib><creatorcontrib>Nolan, Paul E.</creatorcontrib><creatorcontrib>Slack, Marion K.</creatorcontrib><creatorcontrib>Tisdale, James E.</creatorcontrib><creatorcontrib>Hilleman, Daniel E.</creatorcontrib><creatorcontrib>Copeland, Jack G.</creatorcontrib><title>Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta‐Analysis of Dose Response and Timing of Initiation</title><title>Pharmacotherapy</title><addtitle>Pharmacotherapy</addtitle><description>Study Objective. To investigate a possible dose‐response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre‐ or postoperative initiation of amiodarone is superior.
Design. Meta‐analysis of randomized controlled trials.
Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English‐language reports published between 1966 and December 2005.
Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose—categorized as low (< 3000 mg), medium (3000–5000 mg), or high (> 5000 mg)—and preoperative versus postoperative initiation were aggregated by using meta‐analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p<0.001). Although the odds of developing atrial fibrillation appeared to be somewhat higher in the low‐dose group, no significant differences were noted in the odds ratios (ORs) of developing atrial fibrillation among the low‐, medium‐, and high‐dose groups: OR 0.58, 95% confidence interval (CI) 0.44–0.77; OR 0.45, 95% CI 0.30–0.69; and OR 0.44, 95% CI 0.33–0.58; respectively (p=0.238). In addition, the ORs for atrial fibrillation development associated with preoperative and postoperative initiation of amiodarone were not significantly different (OR 0.50, 95% CI 0.39–0.63; and OR 0.48, 95% CI 0.37–0.63; respectively, p=0.862).
Conclusion. Total amiodarone doses of 3000 mg or higher may be more effective than lower doses in reducing the rate of postoperative atrial fibrillation after cardiac surgery. Preoperative initiation of amiodarone appears to be unnecessary. These findings require confirmation in prospective, randomized trials.</description><subject>amiodarone</subject><subject>Amiodarone - administration & dosage</subject><subject>Amiodarone - therapeutic use</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>cardiac surgery</subject><subject>Cardiology. Vascular system</subject><subject>Heart</subject><subject>Humans</subject><subject>Incidence</subject><subject>Medical sciences</subject><subject>meta‐analysis</subject><subject>Pharmacology. Drug treatments</subject><subject>Postoperative Complications - prevention & control</subject><subject>Postoperative Period</subject><subject>Preoperative Care</subject><subject>prophylaxis</subject><subject>Thoracic Surgery</subject><subject>Time Factors</subject><subject>Vasodilator Agents - administration & dosage</subject><subject>Vasodilator Agents - therapeutic use</subject><issn>0277-0008</issn><issn>1875-9114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><recordid>eNp90DFv1DAYBmALUdGjMLIiL7Dl6s9O7IQtOiit1Iqq3G59cZzWKImDnRNkgp_Ab-SX4Oud1I3Jlv34tf0S8gbYGoqKn08Pxq-5Wou1kOwZWUGpiqwCyJ-TFeNKZYyx8pS8jPEbYxxkzl-QU1ACJOTlivyqB-dbDH609Db46WHp8aeLtPOB1nNw2NML1wTX9zg7P9K6m22gGwytQ0O_7sK9DcsHemNn_Pv7Tz1iv8R03Hf0o4-W3tk4-TFNcGzp1g1uvN_vXY1udo-Br8hJh320r4_jGdlefNpuLrPrL5-vNvV1ZkR6coYKUFksCoMlq0zHrCwrgYpzYNCysoFWMAUyrQMz3ORtkTedyWVeWWkbcUbeH2Kn4L_vbJz14KKx6Vej9buoZcWErAqeYHaAJvgYg-30FNyAYdHA9L5wvS9cc6WFToUn__YYvGsG2z7pY8MJvDsCjAb7LuBoXHxyZVGCyCE5fnA_XG-X_9-qby_rO8G5-AfFPJtX</recordid><startdate>200703</startdate><enddate>200703</enddate><creator>Buckley, Mitchell S.</creator><creator>Nolan, Paul E.</creator><creator>Slack, Marion K.</creator><creator>Tisdale, James E.</creator><creator>Hilleman, Daniel E.</creator><creator>Copeland, Jack G.</creator><general>Blackwell Publishing Ltd</general><general>Pharmacotherapy</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200703</creationdate><title>Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta‐Analysis of Dose Response and Timing of Initiation</title><author>Buckley, Mitchell S. ; Nolan, Paul E. ; Slack, Marion K. ; Tisdale, James E. ; Hilleman, Daniel E. ; Copeland, Jack G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3642-a71a7ea55ca809cf0e6893a722101d08b1d307160e610c2c4d54bfc4649e6eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>amiodarone</topic><topic>Amiodarone - administration & dosage</topic><topic>Amiodarone - therapeutic use</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>cardiac surgery</topic><topic>Cardiology. Vascular system</topic><topic>Heart</topic><topic>Humans</topic><topic>Incidence</topic><topic>Medical sciences</topic><topic>meta‐analysis</topic><topic>Pharmacology. Drug treatments</topic><topic>Postoperative Complications - prevention & control</topic><topic>Postoperative Period</topic><topic>Preoperative Care</topic><topic>prophylaxis</topic><topic>Thoracic Surgery</topic><topic>Time Factors</topic><topic>Vasodilator Agents - administration & dosage</topic><topic>Vasodilator Agents - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Buckley, Mitchell S.</creatorcontrib><creatorcontrib>Nolan, Paul E.</creatorcontrib><creatorcontrib>Slack, Marion K.</creatorcontrib><creatorcontrib>Tisdale, James E.</creatorcontrib><creatorcontrib>Hilleman, Daniel E.</creatorcontrib><creatorcontrib>Copeland, Jack G.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Buckley, Mitchell S.</au><au>Nolan, Paul E.</au><au>Slack, Marion K.</au><au>Tisdale, James E.</au><au>Hilleman, Daniel E.</au><au>Copeland, Jack G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta‐Analysis of Dose Response and Timing of Initiation</atitle><jtitle>Pharmacotherapy</jtitle><addtitle>Pharmacotherapy</addtitle><date>2007-03</date><risdate>2007</risdate><volume>27</volume><issue>3</issue><spage>360</spage><epage>368</epage><pages>360-368</pages><issn>0277-0008</issn><eissn>1875-9114</eissn><coden>PHPYDQ</coden><abstract>Study Objective. To investigate a possible dose‐response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre‐ or postoperative initiation of amiodarone is superior.
Design. Meta‐analysis of randomized controlled trials.
Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English‐language reports published between 1966 and December 2005.
Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 patients. For each study, the total administered amiodarone dose—categorized as low (< 3000 mg), medium (3000–5000 mg), or high (> 5000 mg)—and preoperative versus postoperative initiation were aggregated by using meta‐analytic techniques. The incidence of postoperative atrial fibrillation was significantly reduced by amiodarone compared with placebo (p<0.001). Although the odds of developing atrial fibrillation appeared to be somewhat higher in the low‐dose group, no significant differences were noted in the odds ratios (ORs) of developing atrial fibrillation among the low‐, medium‐, and high‐dose groups: OR 0.58, 95% confidence interval (CI) 0.44–0.77; OR 0.45, 95% CI 0.30–0.69; and OR 0.44, 95% CI 0.33–0.58; respectively (p=0.238). In addition, the ORs for atrial fibrillation development associated with preoperative and postoperative initiation of amiodarone were not significantly different (OR 0.50, 95% CI 0.39–0.63; and OR 0.48, 95% CI 0.37–0.63; respectively, p=0.862).
Conclusion. Total amiodarone doses of 3000 mg or higher may be more effective than lower doses in reducing the rate of postoperative atrial fibrillation after cardiac surgery. Preoperative initiation of amiodarone appears to be unnecessary. These findings require confirmation in prospective, randomized trials.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>17316148</pmid><doi>10.1592/phco.27.3.360</doi><tpages>9</tpages></addata></record> |
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| subjects | amiodarone Amiodarone - administration & dosage Amiodarone - therapeutic use atrial fibrillation Atrial Fibrillation - drug therapy Biological and medical sciences Cardiac dysrhythmias cardiac surgery Cardiology. Vascular system Heart Humans Incidence Medical sciences meta‐analysis Pharmacology. Drug treatments Postoperative Complications - prevention & control Postoperative Period Preoperative Care prophylaxis Thoracic Surgery Time Factors Vasodilator Agents - administration & dosage Vasodilator Agents - therapeutic use |
| title | Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta‐Analysis of Dose Response and Timing of Initiation |
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