Prophylactic amiodarone in patients with severe aortic stenosis and left ventricular hypertrophy undergoing aortic valve replacement: Silencing the rebels

Ventricular fibrillation occurs commonly after aortic cross clamp in patients undergoing aortic valve replacement for severe aortic stenosis. Amiodarone is a class III antiarrhythmic drug that can be used as a prophylactic measure to prevent reperfusion ventricular fibrillation as ventricular fibrillation increases myocardial oxygen demand and hence myocardial damage. A prospective, randomized, triple blinded study conducted in a single institution, Cardio-thoracic Academy, Ain –Shams University, Cairo, Egypt.120 patients with severe AS enrolled for elective aortic valve replacement. 60 patients received 10 ml of normal saline 9% (control group), while the other 60 patients received a single dose of Amiodarone 150 mg in 10 ml of Dextrose 5% through the pump circuit (Case Group). The incidence of post clamp arrhythmia, need of defibrillation, cardiac support was recorded. 36 patients (60%) of the case group had spontaneous sinus rhythm upon declamping which is significantly lower than control group. The incidence of VF was lower in the case group (P value < 0.001) (highly significant). The number of DC shock required for ventricular defibrillation, total bypass and declamping times were significantly lower in the case group. Prophylactic use of a single dose amiodarone through the pump circuit before cross clamp release reduces the incidence of reperfusion induced ventricular fibrillation and subsequent defibrillation therapy needed.