Amiodarone vs. Sotalol for Atrial Fibrillation Treatment After Open Heart Surgery

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Table of Contents

Background
Objective
Data sources
Study selection
Data synthesis
Limitations
Conclusions
Recommendation
References

Background

Amiodarone and sotalol have been used as modalities in reduction of postoperative AF after open heart surgery. There has been lacking in proof of which one is more efficiency and safety and further statistics reveal that superventricular arrhythmias incidence also accompany AF and range from 20% to 40% ( Aranki, 1996). this analysis seeks to establish the better modality.

Objective

The main goal of this exercise is to establish the efficiency and safety of either amiodarore or sotalol in reduction of AF after surgery through randomization. This is because they are preferred the interventions for reduction of AF (Nursing, 2007).

Data sources

The Amiodarone Reduction in Coronary Heart (ARCH) trial, study by Weber et, previously reported studies, S.F. Aranki, D.P. Shaw, D.H. Adams et al., Predictors of atrial fibrillation after coronary artery surgery, Circulation, 94 (1996), pp. 390–397.

Study selection

Randomized and controlled trials evaluating the efficiency and safety of either amiodarone or sotalol in the reduction of atrial fibrillation (AF) after an open heart surgery.

Data synthesis

A total of 160 patients were randomized, of whom 134 underwent coronary artery bypass graft surgery (CABG) alone, 17 underwent CABG and concomitant aortic valve replacement surgery (AVR), 9 underwent AVR only, and 1 patient’s surgery was canceled. Patients with signs or symptoms of congestive heart failure (CHF), ejection fraction ≤30%, estimated creatinine clearance <30 mL/min, or serum creatinine ≥2.5 mg/dL were excluded. Patients were randomized to receive either sotalol 80 mg 2 times per day (n = 76) or intravenous amiodarone 15 mg/kg over 24 hours followed by oral amiodarone 200 mg 3 times per day (n = 83).

The results were as follows; AF occurred in 17% of patients randomized to amiodarone and 25% of the patients randomized to sotalol (P =.21). However, the duration of AF was significantly shorter in amiodarone-treated patients (169 ± 224 min) compared to sotalol treated patients (487 ± 505 min; P =.04). In a subgroup analysis, the incidence of AF in patients undergoing AVR or CABG with AVR was significantly less with amiodarone (1/15, 7%) compared to sotalol (9/11, 82%) (P <.001). Blood pressure was lower immediately after surgery with amiodarone but comparable to sotalol at 24 hours. Of the hemodynamic indices measured, only stroke volume was significantly lower in patients randomized to sotalol at 24 hours (P =.035).

Table.

Amiodarone (n = 83)		Sotalol (n = 76)
CABG	13/68 (19%)		10/64 (15%)
AVR & CABG/AVR	1/15 (7%)		9/11 (82%)

SOTALOL CONTROL 76 patients

AMIODARONE EXPERIMENTAL 83 patients

Control Event Rate (CER)
- Events / subjects in control group
- CABG=15%
- AVR & CABG=82%
Experimental Event Rate (EER)
- Events / subjects in experimental group
- CABG=19%
- AVR & CABG=7%
Absolute Risk Reduction (or increase) ARR
- CABG=15-19=-4%
- AVR
- CER – EER
- & CABG=82-7=75%
Relative Risk Reduction (or increase) RRR:
- (CER – EER) / CER
- CABG=-4/15=-0.26%
- AVR & CABG=75/82=0.91%
Number Needed to Treat (or Harm) NNT
- 1 / ARR
- CABG=1/-4=-0.25%
- AVR & CABG=1/75=0.0i%
Odds Ratio or Relative Risk : (not really identical, but similar
- CER / EER
- CABG=15/19=0.79%
- AVR & CABG=82/7=11.7%

	CER	EER	ARR	RRR	RR	NNT
CABG	10/64(15%)	13/68(19%)	-4%	-0.26%	0.79%	-0.25%
AVR & CABG	9/11(82%)	1/15(7%)	75%	0.91%	11.7%	0.01%

Limitations

The limitations encountered include an underpowered analysis and a large sample size leading to a significant difference between treatments reflecting a type II error (Nursing, 2007).

Conclusions

In reviewing this article, some conclusion were drawn one of the being similarities when it comes to efficancy and safety in the reduction of postoperative AF in patients undergoing open heart surgery. Those that received sotalol were in need of some more inotropic (Aranki1996).

Recommendation

Amiodarone would be a better intervention over sotalol in reduction of postoperative AF. This is because the latter is more efficient and safer. Sotalol would be a preferred intervention in case of stroke.

References

Aranki, D. S. (1996). Predictors of atrial fibrillation after coronary artery surgery. Chicago: Prentice-Hall.

Nursing, R. C. (2007). Evidence Based Nursing: An Examination of the role of Nursing Within International Evidence Based Health Care Movement. London: Royal College of Nursing.

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