What does this research mean for the field?

A hybrid intravenous and oral amiodarone regimen effectively reduces the risk of post-cardiothoracic surgery atrial fibrillation, whereas atrial septal pacing is ineffective and provides no additive benefit when combined with amiodarone. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This trial aims to investigate the efficacy of intravenous and oral amiodarone versus atrial septal pacing in preventing atrial fibrillation after cardiothoracic surgery.

September 9, 2003CirculationOpen Access

Intravenous Plus Oral Amiodarone, Atrial Septal Pacing, or Both Strategies to Prevent Post-Cardiothoracic Surgery Atrial Fibrillation: The Atrial Fibrillation Suppression Trial II (AFIST II)

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Why the study?

Does intravenous plus oral amiodarone, atrial septal pacing, or both reduce post-cardiothoracic surgery atrial fibrillation in patients undergoing cardiothoracic surgery?

Population

160 patients undergoing cardiothoracic surgery (CTS)

Comparison

Amiodarone and/or atrial septal pacing for 96… vs Placebo and/or no pacing

Design

RCT, Randomized to amiodarone or placebo and then to pacing or no pacing using…

Authors

CWC Michael WhiteGeneral / Preventive / Lipids MCMichael F. CaronGilead Sciences (United States)JKJames S. KalusHenry Ford Health System

Discussion

Member takes

Implication

Hybrid amiodarone reduces post-cardiothoracic surgery AF; supports prophylactic use and challenges atrial septal pacing.

Key Points

This trial aims to investigate the efficacy of intravenous and oral amiodarone versus atrial septal pacing in preventing atrial fibrillation after cardiothoracic surgery.
Randomized 2x2 factorial design with 160 patients
Intravenous amiodarone (1050 mg) followed by oral (4800 mg) for 4 days
Atrial septal pacing for 96 hours post-surgery, comparing against placebo
Amiodarone reduced AF risk by 43% (P=0.037) and symptomatic AF by 68% (P=0.019) compared to placebo.
The combination of amiodarone and pacing resulted in a 57.9% lower AF incidence compared to placebo with no pacing (P=0.047).
Atrial septal pacing alone showed no significant effect on AF incidence.

Structured PICO

Does intravenous plus oral amiodarone, atrial septal pacing, or both reduce post-cardiothoracic surgery atrial fibrillation in patients undergoing cardiothoracic surgery?

Population

160 patients undergoing cardiothoracic surgery (CTS)

Intervention

Amiodarone (intravenous infusion for the first 24 hours [1050 mg total] followed by oral therapy for 4 postoperative days [4800 mg total]) and/or atrial septal pacing for 96 hours, starting within 6 hours post-CTS

Comparator

Placebo and/or no pacing

Outcome

Post-cardiothoracic surgery atrial fibrillation (AF) and symptomatic AFhard clinical

A hybrid intravenous and oral amiodarone regimen effectively reduces post-cardiothoracic surgery atrial fibrillation, whereas atrial septal pacing is ineffective.

Cite This Study

White et al. (2003) studied this question.

synapsesocial.com/papers/6a1bd121ea84844e355f0525 https://doi.org/10.1161/01.cir.0000087445.59819.6f

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF AF ablation outcomes

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Intravenous Plus Oral Amiodarone, Atrial Septal Pacing, or Both Strategies to Prevent Post-Cardiothoracic Surgery Atrial Fibrillation: The Atrial Fibrillation Suppression Trial II (AFIST II)

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Intravenous Plus Oral Amiodarone, Atrial Septal Pacing, or Both Strategies to Prevent Post-Cardiothoracic Surgery Atrial Fibrillation: The Atrial Fibrillation Suppression Trial II (AFIST II)

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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