Transient new-onset atrial fibrillation during general thoracic operations and its treatment with amiodarone: a retrospective analysis in a single centre.

OBJECTIVES: This study aims to examine the effects of amiodarone in restoring sinus rhythm in patients with new-onset atrial fibrillation during thoracic operations.

METHODS: A total of 12 305 consecutive patients undergoing elective lung/oesophageal surgery were screened. Data analysis included 416 patients with new-onset atrial fibrillation not receiving any antiarrhythmic agents (control group, n = 235) or receiving amiodarone (amiodarone group, n = 181).

RESULTS: In the analysis that included all cases (lung and oesophageal surgery), the rate of recovery to sinus rhythm during surgery was 22.1% (52/235) in the control group vs 23.2% (42/181) in the amiodarone group (P = 0.795). A multivariable analysis showed that intraoperative sinus rhythm recovery was not associated with the use of amiodarone [odds ratio 0.91, 95% confidence interval (CI) 0.56-1.50]. Sinus rhythm was achieved eventually during the postoperative period in all patients who failed to achieve sinus rhythm during the surgery (n = 322). However, a Kaplan-Meier analysis showed earlier recovery in the amiodarone group (median time of 1.1 days, 95% CI 0.97-1.24 vs 1.8 days, 95% CI 1.62-2.04; P < 0.001). In a subgroup analysis that only included patients receiving lung surgery (n = 345), the rate of recovery to sinus rhythm during surgery was 17.5% (35/200) in the control group vs 21.4% (31/145) in the amiodarone group (P = 0.366). Time to sinus rhythm recovery was 1.5 days (95% CI 1.48-1.86) in the control group and 1.1 days (95% CI 1.07-1.40) in the amiodarone group (P < 0.001). The rate of severe hypotension after amiodarone treatment was 6.6% (12/181).

CONCLUSIONS: Amiodarone does not affect the rate of sinus rhythm recovery during thoracic surgery but could shorten the time to sinus rhythm recovery after the surgery.