Key result
Amiodarone (37%) and lidocaine (38%) administered before aortic declamping significantly reduced the incidence of ventricular fibrillation compared to placebo (70%, P=.017).
Why the study?
Does lidocaine or amiodarone prevent ventricular fibrillation in patients undergoing elective coronary artery bypass grafting?
RCT (n=86)
Double-blind
randomized
Does lidocaine or amiodarone prevent ventricular fibrillation in patients undergoing elective coronary artery bypass grafting?
Absolute Event Rate: 37% vs 70%
p-value: p=.017
Both amiodarone and lidocaine effectively reduce the incidence of ventricular fibrillation after aortic declamping during CABG, but amiodarone further reduces the need for electrical defibrillation.
Supports prophylactic amiodarone or lidocaine before declamping in CABG; extends RCT evidence for reperfusion VF prevention.
OBJECTIVE: Ventricular fibrillation is common after aortic declamping in patients undergoing open heart surgery. This situation has a negative impact on morbidity and mortality. The aim of this prospective study was to compare the effect of administering lidocaine versus amiodarone before aortic declamping during elective coronary bypass grafting, paying close attention to when the initial effect of amiodarone sets in. METHODS: In this double blind, prospective, randomized, controlled study, 86 patients who were candidates for elective coronary artery bypass grafting were recruited into three groups: group lidocaine (group L, n=29); group amiodarone (group A, n=27); and group placebo (group P, n=30). Group L patients received 1.5 mg/kg of lidocaine 2 minutes before aortic declamping and group A patients received 300 mg of amiodarone intravenously 15 minutes before release of the aortic cross clamp. The primary endpoints were the incidence of ventricular fibrillation and the number of shocks required to terminate ventricular fibrillation. RESULTS: The frequency of ventricular fibrillation occurrence was significantly higher in group P (70%) when compared with group A (37%) and group L (38%) (P=.017). There was no statistically significant difference between the amiodarone and the lidocaine groups regarding ventricular fibrillation. However, when ventricular fibrillation occurred, the percentage of patients requiring electrical defibrillation was significantly higher in both group L and group P when compared with group A (P=.023). CONCLUSION: We suggest that during coronary arterial bypass surgery, administration of an amiodarone regime before release of the aortic cross clamp, paying particular attention to the start of the initial effect of amiodarone, is no more effective than lidocaine for prevention from arrhythmia; however, amiodarone reduces the need for electrical defibrillation.
No takes yet. Share an insight, caveat, or question.
Yılmaz et al. (2014) conducted an RCT in Elective coronary artery bypass grafting (n=86). Lidocaine or Amiodarone vs. Placebo was evaluated on Incidence of ventricular fibrillation and the number of shocks required to terminate ventricular fibrillation (p=.017). Amiodarone (37%) and lidocaine (38%) administered before aortic declamping significantly reduced the incidence of ventricular fibrillation compared to placebo (70%, P=.017).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: