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Amiodarone Halves Post-Op Atrial Tachyarrhythmias

PAPABEAR study suggests amiodarone prevents tachyarrhythmias after heart surgery

WEDNESDAY, Dec. 28 (HealthDay News) -- Results of a large multicenter trial of patients undergoing elective heart surgery shows that a 13-day perioperative course with amiodarone cuts the incidence of sustained atrial tachyarrhythmia in half, according to results of PAPABEAR, published in the Dec. 28 issue of the Journal of the American Medical Association.

The Prophylactic Amiodarone for the Prevention of Arrhythmias that Begin Early After Revascularization, Valve Replacement or Repair (PAPABEAR) is a placebo-controlled, randomized trial involving 601 patients who underwent elective CABG, valve repair or both between Feb. 1, 1999 and Sept. 26, 2003. Patients received oral amiodarone or placebo beginning six days before and continuing until six days after surgery, for a total of 13 days.

Principal investigator L. Brent Mitchell, M.D., of the University of Calgary, Canada, reports that after one year of follow-up, amiodarone cut in half the incidence of atrial tachyarrhythmia lasting five minutes or longer.

Postoperative sustained ventricular tachyarrhythmia occurred in one patient out of 299 receiving amiodarone, or 0.3%, compared with eight of 302 in the placebo group, or 2.6%. Incidence of serious postoperative complications, in-hospital mortality, one-year mortality or readmission to the hospital within six months of surgery was similar in the two groups.

"The number needed to treat [with amiodarone] to prevent one patient from developing postoperative atrial tachyarrhythmia was only 7.5 overall and was even lower in older patients, in patients having valve surgery and in patients not receiving concomitant beta-blocker therapy," the authors write.

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