Effect of prophylactic oral amiodarone on postoperative outcomes in patients with preoperative atrial fibrillation undergoing cardiac valve surgery for rheumatic heart disease

Background Atrial fibrillation(AF) is the most common arrhythmia in patients with rheumatic heart disease(RHD). The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery(CVS) is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence(30/135, 22.2%) was higher than that in the control group(45/427, 10.5%, P < 0.05). Compared with patients in the control group,incidence of rapid AF(19.3% vs 27.4%) and ventricular arrhythmias(6.7% vs 12.1%) in the amiodarone group were significantly lower(P < 0.05). Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group(P < 0.05). The sinus rhythm conversion rate of the patients with total dosage of above 10 g(14/43, 32.6%) was significantly higher than that of the patients receiving less than 10 g(16/92, 17.4%) amiodarone(P < 0.05). Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.