Efficacy of prophylactic use of sotalol versus amiodarone in the prevention of new onset post operative atrial fibrillation post off pump coronary artery bypass surgery

Background: Atrial fibrillation (AF) is one of the most common arrhythmias following cardiac surgery, occurring in 20-40% of cases, and contributes significantly to increased ICU and hospital stay. While studies exist on sotalol and amiodarone individually for preventing new-onset AF post off-pump CABG, no study has directly compared their effectiveness. Methods: Seventy-two patients undergoing off-pump CABG were randomised equally into two groups of 36. Group A received IV Amiodarone 6 mg/kg 30 minutes pre-incision, continued as oral Amiodarone 200 mg BD for 3 days then 100 mg BD for 2 days postoperatively. Group S received oral Sotalol 80 mg on the morning of surgery, continued at 80 mg BD postoperatively. Included patients had diabetes mellitus, hypertension, and preserved LV systolic function. Exclusion criteria comprised of COPD, CKD, PVD, moderate-to-severe LV dysfunction, emergency surgery, and pre-existing AF. Results: Post-operative AF (POAF) occurred in 25% of Group A and 27.77% of Group S, with all cases presenting on post-operative day 2. No statistically significant differences were found between groups across heart rate, blood pressure, graft count, inotropic score, ICU stay, hospital stay, or ventilation duration. The only notable difference was cost Rs.170 for amiodarone versus Rs.10 for sotalol favouring sotalol. Conclusions: Amiodarone and sotalol demonstrated comparable efficacy in preventing POAF following off-pump CABG. A larger study with broader inclusion criteria is recommended to better define the relative effectiveness of both agents.