A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study.

Abstract

OBJECTIVE:

The aim of this prospective observational study was to evaluate the efficiency of a new escalating treatment strategy with vernakalant, flecainide and electrical cardioversion (EC) in patients with new onset atrial fibrillation (AF) after cardiac surgery.

MATERIAL AND METHODS:

24 patients with new onset AF after aortic valve surgery, coronary artery bypass surgery or combined procedures were evaluated in this study. Additional including criteria were age between 18 and 80, duration of AF less than four days, body weight less than 100 kg and no previous treatment with class I or III antiarrhythmic drugs. Exclusion criteria were poor left ventricular ejection fraction (LVEF < 40%) and history of myocardial infarction within 30 days. The patients were divided into converters and non-converters according to their response to combination treatment with vernakalant and flecainide, and the groups were compared.

RESULTS:

The mean age of the population was 69.6 ± 6.3 years and 26.1% of patients were female. There were no statistically significant differences between the two groups in terms of height, weight, gender distribution, comorbidities, preoperative medication, left ventricular function and left atrium diameter. Interventricular septum (IVS) in the non-converted group was significantly thicker compared to the converted group: 14.0 ± 1.00 vs. 10.40 ± 2.59 mm (p = 0.036). While 14 patients (60.9%) were successfully converted into stable sinus rhythm by pharmacological treatment with vernakalant and flecainide, 9 patients (39.1%, non-converted group) remained in AF. However, seven of them could be converted after additional EC.

CONCLUSION:

The combination of vernakalant and flecainide improves the conversion rate into a stable sinus rhythm in postcardiotomy patients with new onset AF compared to single drug therapy. Furthermore it might be an excellent precondition for successful EC in patients who are not converted after using both antiarrhtythmic drugs. Furthermore, left ventricular hypertrophy might be a potential negative predictor of successful pharmacological cardioversion.

• Authors: Mohamed Zeriouh, Anton Sabashnikov, Yeong-Hoon Choi, Javid Fatullayev, Hannes Reuter, Aron-Frederik Popov, Georg Langebartels, Lucas Kimmig, Parwis B Rahmanian, Thorsten Wittwer, Klaus Neef, Jens Wippermann, Thorsten Wahlers
• Journal: Journal of cardiothoracic surgery (J Cardiothorac Surg) Vol. 9 Pg. 83 (May 12 2014) ISSN: 1749-8090 [Electronic] England
• PMID: 24886207 (Publication Type: Clinical Trial, Journal Article, Observational Study)

Chemical References

• Anti-Arrhythmia Agents

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (etiology, physiopathology, therapy)
• Cardiac Surgical Procedures (adverse effects)
• Electric Countershock (methods)
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Practice Guidelines as Topic
• Prospective Studies
• Stroke Volume (physiology)
• Treatment Outcome
• Young Adult