Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the amiodarone reduction in coronary heart (ARCH) trial

OBJECTIVES This study was designed to test whether intravenous (IV) amiodarone would prevent atrial fibrillation and decrease hospital stay after open heart surgery. BACKGROUND Atrial fibrillation commonly occurs after open heart procedures and is thought to be significant determinant for prolongation of hospitalization. Oral amiodarone given preoperatively appears to reduce the incidence of atrial fibrillation. This study was designed to test whether the more rapid-acting IV formulation of amiodarone given postoperatively would reduce the incidence of atrial fibrillation. METHODS Three hundred patients undergoing standard open heart surgery were randomized in double-blind fashion to IV amiodarone (1 g/day for 2 days) versus placebo immediately after open heart surgery. The primary end points of the trial were incidence of atrial fibrillation and length of hospital stay. Baseline clinical variables and mortality and morbidity dat were collected. RESULTS Atrial fibrillation occurred in 67/142 (47%) patients on placebo versus 56/158 (35%) on amiodarone (p = 0.01). Length of hospital stay for the placebo group was 8.2 ± 6.2 days, and 7.6 ± 5.9 days for the amiodarone group (p = 0.34). No differences were noted in baseline variables, morbidity or mortality. CONCLUSIONS Low-dose IV amiodarone was safe and effective in reducing the incidence of atrial fibrillation after heart surgery, but did not significantly alter length of hospital stay.