COMPARISON OF AMIODARONE VERSUS MAGNESIUM SULPHATE IN PREVENTION OF POST OPERATIVE ARRHYTHMIAS IN OPEN HEART SURGERY: A RANDOMIZED CONTROLLED TRIAL AT LADY READING HOSPITAL PESHAWAR

Main Article Content

Amjid Ali
Muhammad Haseeb Moin Ud Din Baloch
Sayed Shah Hassanain
Muhammad Izaz
Muhammad Aftab Ahmad

Abstract

Objective: To compare the frequency of postoperative arrhythmias with amiodarone versus magnesium sulphate in patients undergoing open heart surgery


Methodology: This randomized Controlled trial was done at Department of Anethesia Lady Reading Hospital, Peshawar. Eighty patients of age 40-70 years, either gender undergoing open heart surgery under general anes­thesia were enrolled via Non-probability, consecutive sampling technique. Then they were divided in two groups by using lottery method. In group A, patients were given loading dose of amiodarone 5mg/Kg and in group B, patients were given 2g of MgSO4 in 100ml of isotonic 0.9% solution intravenously. After surgery, patients were followed-up there for 3 days. Patients were monitored through ECG monitor for postoperative arrhythmias.


Results: The mean age of patients was 49.93±7.38 years in amiodarone group while 51.45±7.31yeas in MgSO4 group. There were 26 (65%) males and 14 (35%) females in group A while 15 males (37.5%) and 25 females (62.5%) in group B. Postoperative arrhythmias were observed in 10 (25%) cases with amiodarone while in 16 (40%) cases with MgSO4, although the difference was insignificant (p>0.05).


Conclusion: The frequency of postoperative arrhythmias is reduced with using amiodarone than MgSO4.

Article Details

How to Cite
1.
Amjid Ali, Muhammad Haseeb Moin Ud Din Baloch, Sayed Shah Hassanain, Muhammad Izaz, Muhammad Aftab Ahmad. COMPARISON OF AMIODARONE VERSUS MAGNESIUM SULPHATE IN PREVENTION OF POST OPERATIVE ARRHYTHMIAS IN OPEN HEART SURGERY: A RANDOMIZED CONTROLLED TRIAL AT LADY READING HOSPITAL PESHAWAR. J Postgrad Med Inst [Internet]. 2023 Nov. 6 [cited 2024 Mar. 1];37(4):238-43. Available from: https://jpmi.org.pk/index.php/jpmi/article/view/3300
Section
Original Article

References

Dua N, Kumra VP. Management of perioperative arrhythmias. Indian J An¬aesth. 2007;51(4):310-23.

Helgadottir S, Sigurdsson MI, Ingvars¬dottir IL, Arnar DO, Gudbjartsson T. Atri¬al fibrillation following cardiac surgery: risk analysis and long-term survival. J Cardiothorac Surg. 2012;7(1):87.

Peretto G, Durante A, Limite LR, Cian¬flone D. Postoperative arrhythmias after cardiac surgery: incidence, risk factors, and therapeutic management. Cardiol Res Pract. 2014;2014:615987.

Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Eu¬ropace. 2011;14(2):159-74.

Kamali A, Sanatkar A, Sharifi M, Moshir E. Evaluation of amiodarone versus metoprolol in treating atrial fibrillation after coronary artery bypass grafting. Int Med Appl Sci. 2017;9(2):1-5. DOI: 10.1556/1646.9.2017.11.

El Amrousy D, Elshehaby W, El Feky W, Elshmaa NS. Safety and efficacy of prophylactic amiodarone in preventing early junctional ectopic tachycardia (JET) in children after cardiac surgery and determination of its risk factor. Pe¬diatr Cardiol. 2016;37(4):734-9. DOI 10.1007/s00246-016-1343-5.

Naghipour B, Faridaalaee G, Shadvar K, Bilehjani E, Khabaz AH, Fakhari S. Effect of prophylaxis of magnesium sulfate for reduction of postcardiac surgery ar¬rhythmia: Randomized clinical trial. Ann Cardiac Anaesth 2016;19(4):662. DOI: doi: 10.4103/0971-9784.191577.

Esmail M, Nilufar D, Majid G-E, Reza T-NM, Abolfazl M. Prophylactic effect of amiodarone in atrial fibrillation af¬ter coronary artery bypass surgery; a double-blind randomized con¬trolled clinical trial. J Cardiovasc Dis Res. 2015;6(1):12-7. DOI: 10.5530/ jcdr.2015.1.2.

Haverkamp W, Hachenberg T. Post-thoracotomy dysrhythmia. Cur¬rent opinion in anaesthesiology 2016;29(1):26-33. DOI: 10.1097/ ACO.0000000000000285.

Al-Ghamdi B. Arrhythmias Post Coro¬nary Artery Bypass Surgery. Coronary Artery Bypass Graft Surgery: Intech Open. 2017;20:07. DOI: 10.5772/inte¬chopen.70423.

Shahidi M, Bakhshandeh H, Rahmani K, Afkhamzadeh A. Hypomagnesaemia and other electrolytes imbalances in open and closed pediatrics cardiac sur¬gery. Pak J Med Sci. 2019;35(2):353-9. DOI: 10.12669/pjms.35.2.367.

Naghipour B, Faridaalaee G, Shadvar K, Bilehjani E, Khabaz AH, Fakhari S. Effect of prophylaxis of magnesium sulfate for reduction of postcardiac surgery ar¬rhythmia: Randomized clinical trial. Ann Card Anaesth. 2016;19(4):662-7. DOI: 10.4103/0971-9784.191577.

Shepherd J, Jones J, Frampton G, Turn¬er D, Price A. Intravenous magnesium sulphate and sotalol for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and economic evaluation. NIHR Health Technology Assessment programme: Executive Summaries. NIHR J Library. 2008;12(28):3-5.

January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. AHA/ ACC/HRS guideline for the manage¬ment of patients with atrial fibrillation: a report of the American College of Cardi-ology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardi¬ol. 2014;64(21):e1-76. DOI: 10.1161/ CIR.0000000000000665.

Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, et al. AATS guidelines for the prevention and management of peri-operative atrial fibrillation and flutter (POAF) for thorac¬ic surgical procedures. J Thorac Car¬diovasc Surg. 2014;148(3):e153. DOI: 10.1016/j.jtcvs.2014.06.036.

Yadava M, Hughey AB, Crawford TC. Postoperative atrial fibrillation: inci¬dence, mechanisms, and clinical cor¬relates. Heart Fail Clin. 2016;12(2):299- 308. DOI: 10.1016/j.hfc.2015.08.023

Philip I, Berroëta C, Leblanc I. Periop¬erative challenges of atrial fibril¬lation. Curr Opin Anaesthesiol. 2014;27(3):344-52. DOI: 10.1097/ ACO.0000000000000070.

Raiten JM, Ghadimi K, Augoustides JG, Ramakrishna H, Patel PA, Weiss SJ, et al. Atrial fibrillation after cardiac sur¬gery: clinical update on mechanisms and prophylactic strategies. J Cardio¬thorac Vasc Anesth. 2015;29(3):806- 16. DOI: 10.1053/j.jvca.2015.01.001.

Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postopera¬tive atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg. 2017;52(4):665- 72. DOI: 10.1093/ejcts/ezx039.

Treggiari-Venzi M, Waeber JL, Perneger T, Suter P, Adamec R, Romand JA. In¬travenous amiodarone or magnesium sulphate is not cost-beneficial prophy¬laxis for atrial fibrillation after coronary artery bypass surgery. Br J Anaesth. 2000;85(5):690-5.

Tiryakioglu O, Demirtas S, Ari H, Tiryaki¬oglu SK, Huysal K, Selimoglu O, et al. Magnesium sulphate and amiodarone prophylaxis for prevention of post¬operative arrhythmia in coronary by-pass operations. J Cardiothorac Surg. 2009;4:8.

Bashir I, Abbas S. Comparison of amiodarone vs magnesium sulphate in the prevention of atrial fibrillation after coronary artery bypass grafting surgery. Pak Armed Forces Med J. 2013;63(1):127-32.

Atreya AR, Priya A, Pack QR, Pekow PS, Stefan M, Lagu T, et al. Use and Out¬comes Associated With Perioperative Amiodarone in Cardiac Surgery. J Am Heart Assoc. 2019;8(15):e009892. DOI: 10.1161/JAHA.118.009892.

Habibollahi P, Jam SH, Vahdati SS, Baghi HM, Amiri H. Amiodaron in atri¬al fibrillation: post coronary artery bypass graft. World J Emerg Med. 2016;7(4):250-4. DOI: 10.5847/ wjem.j.1920-8642.2016.04.002.

Zebis LR, Christensen TD, Thom¬sen HF, Mikkelsen MM, Folkersen L, Sørensen HT, et al. Practical regimen for amiodarone use in preventing postoper¬ative atrial fibrillation. Ann Thorac Surg. 2007;83(4):1326-31.

Zebis LR, Christensen TD, Kristiansen IS, Hjortdal VE. Amiodarone cost effec¬tiveness in preventing atrial fibrillation after coronary artery bypass graft sur¬gery. Ann Thorac Surg. 2008;85(1):28- 32.

Bar-Cohen Y, Silka MJ. Management of postoperative arrhythmias in pediatric patients. Curr Treat Options Cardiovasc Med. 2012;14(5):443-54.

Balaji S. Postoperative Cardiac Arrhyth¬mias in Children. Curr Treat Options Cardiovasc. 2001;3(5):385-92.

Khalil AA, Ali AS, Soliman AM, Almahdoy EI. Amiodarone and Magnesium Sul¬phate in Arrhythmia Prophylaxis in Pedi¬atric Congenital Heart Diseases Patients Undergoing Cardiopulmonary Bypass. Egypt J Hosp Med. 83(1), 882-88. DOI: 10.21608/ejhm.2021.158068.

Akram MA, Naseer M, Khurshid H, Ali N, Chaudhry IA. Comparison of Amiodarone with Combined Doses of Magnesium Sulphate and Lidocaine for Prevention of Ventricular Fibrilla¬tion Following Coronary Clamp Re¬lease During Coronary Artery Bypass Graft Surgery. Pak Armed Forces Med J. 2022;72(SUPPL-3), S565–69. DOI: 10.51253/pafmj.v72iSUPPL-3.9554.