ARE PATIENTS RECEIVING AMIODARONE AT INCREASED RISK FOR CARDIAC OPERATIONS

Amiodarone therapy has been implicated as a risk factor for cardiothor acic surgical procedures. In patients undergoing map-guided surgical p rocedures for the treatment of ventricular tachycardia, we compared th e perioperative course of those receiving long-term amiodarone therapy (n = 36) versus that in those not receiving the drug (n = 31). The tw o groups were similar with respect to age, sex, presenting symptoms, f unctional class, extent of coronary artery disease, presence of a vent ricular aneurysm, technique of ventricular tachycardia ablation, cross -clamp or pump time, the number of vessels grafted, the operative flui d balance, and a need for intraaortic balloon pump or inotropic agent support. In 5 patients receiving amiodarone, epinephrine was required to maintain a normal systemic vascular resistance and adequate arteria l pressure. Postoperatively, 6 patients (17%) on amiodarone therapy su ffered acute respiratory failure. In spite of aggressive therapy, 3 of these patients died. Only 1 patient not receiving amiodarone died of a stroke. We conclude that amiodarone therapy in patients undergoing o pen heart operations is associated with an increased risk of severe pu lmonary complications (p = 0.03 by Fisher's exact test). Amiodarone th erapy should be withheld in patients with ventricular tachycardia unti l they have been assessed as candidates for possible surgical interven tion.