D. Amar et al., Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery, J THOR SURG, 120(4), 2000, pp. 790-798
Citations number
39
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objectives: We sought to determine whether early prophylaxis with an L-type
calcium channel blocker reduces the incidence and morbidity associated wit
h atrial fibrillation/flutter and supraventricular tachyarrhythmia after ma
jor thoracic operations.
Methods: In this randomized, double-blind, placebo-controlled study, 330 pa
tients were given either intravenous diltiazem (n = 167) or placebo (n = 16
3) immediately after lobectomy (greater than or equal to 60 years) or pneum
onectomy (greater than or equal to 18 years) and orally thereafter for 14 d
ays. The primary end point with respect to efficacy was a sustained (greate
r than or equal to 15 minutes) or clinically significant atrial arrhythmia
during treatment.
Results: Postoperative atrial arrhythmias (atrial fibrillation/flutter = 60
; supraventricular tachyarrhythmias = 5) occurred in 25 (15%) of the 167 pa
tients in the diltiazem group and 40 (25%) of the 163 patients in the place
bo group (P =.03). When compared with placebo, diltiazem nearly halved the
incidence of clinically significant arrhythmias (17/167 [10%] vs 31/163 [19
%], P =.02), The 2 groups did not differ in the incidence of other major po
stoperative complications or overall duration or costs of hospitalization.
No serious adverse effects caused by diltiazem were seen.
Conclusions: After major thoracic operations, prophylactic diltiazem reduce
d the incidence of clinically significant atrial arrhythmias in patients co
nsidered at high risk for this complication.