Cemal Levent BİRİNCİOĞLU, Ali İhsan PARLAR, Ümit KERVAN, Haşmet BARDAKÇI, Ahmet Tulga ULUS, Özgür ERSOY, Ferit ÇİÇEKÇİOĞLU, Salih Fehmi KATIRCIOĞLU

Koroner bypass cerrahisinden sonra gelişen atriyal fibrilasyon tedavisinde amiodaronun etkinliği

Amaç: Bu çalışmada, koroner arter bypass greftleme (KABG) cerrahisi sonrasında erken dönemde gelişen atriyal fibrilasyon (AF) tedavisinde amiodaron kullanımının etkinliği ve güvenilirliği değerlendirildi.Çalışma planı: Çalışmaya, iskemik kalp hastalığı nedeniyle KABG cerrahisi uygulanan ve ameliyattan sonra erken dönemde AF gelişmesi nedeniyle amiodaron kullanılan 20 hasta (15 erkek, 5 kadın; ort. yaş 64±9; dağılım 43-79) alındı. Amiodaron, yükleme dozunu (150 mgr/10 dk) takiben ilk 0-6 saatte 1 mgr/dk, 6-24 saatte 0.5 mgr/dk infüzyon şeklinde verildi. Yirmi dört saatte 1000-1200 mgr intravenöz amiodaron verildikten sonra günlük 400 mgr (2x200 mgr) oral doza geçildi.Bulgular: Hastaların AF'ye giriş zamanları ortalama 21.0±23.2 saat idi; AF'ye giriş 10 hastada ilk sekiz saatte görülürken, 10 hastada 13-70. saatler arasında meydana geldi. Sekiz hasta (%40) amiodaron tedavisi ile ortalama 25.4±22.0 saatte sinüs ritmine döndü. On iki hasta (%60) ise AF ritminde kaldı. Üç hastaya (%15) amiodaron tedavisinden yedi gün sonra elektriksel kardiyoversiyon uygulandı. Üç hasta (%15) ise AF ritmi ile taburcu edildi. Mortalite yedi hastada (%35) görüldü; bunların altısı amiodaron tedavisine rağmen AF ritminde kalan hastalardı. Atriyal fibrilasyon sonrası yedi hastada (%35) inotrop gereksinimi, iki hastada (%10) intraaortik balon pompası ihtiyacı oldu. Amiodarona başlandıktan sonra dört hastada (%20) bradikardi gelişti. Atriyal fibrilasyon ritminde kalan hastalarda ameliyat sonrası destek ihtiyacı anlamlı derecede yüksek bulunurken (p

The efficacy of amiodarone in the treatment of atrial fibrillation occurring after coronary bypass surgery

Background: The purpose of this study was to evaluate the safety and efficacy of amiodarone in the treatment of newonset atrial fibrillation (AF) after coronary artery bypass grafting (CABG) surgery.Methods: The study included 20 patients (15 males, 5 females; mean age 64±9 years; range 43 to 79 years) who underwent CABG surgery for ischemic heart disease and received amiodarone treatment for AF that developed in the early postoperative period. Amiodarone was administered with an initial infusion of 150 mg/10 min, followed by infusions of 1 mg/ min (first 0-6 hours) and 0.5 mg/min (6-24 hours). Following completion of 1,000-1,200 mg intravenous infusions, oral administration was continued with 400 mg (2x200 mg).Results: The mean time to AF development was 21.0±23.2 hours; the onset of AF was within the first eight hours in 10 patients, and between 13 to 70 hours in the remaining patients. Eight patients (40%) converted to sinus rhythm with amiodarone treatment within a mean of 25.4±22.0 hours, while 12 patients (60%) had persistent AF. Of these, three patients (15%) underwent electrical cardioversion on the seventh day of amiodarone treatment, and three patients were discharged with AF. Mortality occurred in seven patients (35%), of whom six had persistent AF. Following the development of AF, seven patients (35%) required inotropic support, and two patients (10%) required intraaortic balloon pump insertion. Bradycardia was seen in four patients (20%) following initiation of amiodarone. Patients with persistent AF showed significantly high rates of postoperative support (p

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