PROPHYLACTIC EFFECT OF A SINGLE INTRAVENOUS DOSE OF A COMBINATION OF DIGOXIN, HYDROCORTISONE, AND AMIODARONE ON ATRIAL FIBRILLATION AFTER OFF-PUMP CORONARY ARTERY BYPASSES GRAFT SURGERY

Abstract

Objective: Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass graft surgery (CABG) and a major cause of increased hospital costs. Dispersed atrial refractoriness is thought to be the primary mechanism, whereas myocardial inflammation has an important role in altering atrial conduction. We evaluated the preventive effect of an intravenous combination of Digoxin, Hydrocortisone, and Amiodarone as anti-inflammatory and anti-arrhythmic agents on AF after off-pump CABG.<br />Material and Methods: One hundred fifty patients who underwent off-pump CABG between March 2010 and April 2011 and met our inclusion criteria were enrolled. The patients were randomized into two groups: the study group received 300 mg Amiodarone, 0.5 mg Digoxin, and 200 mg Hydrocortisone before the induction of anesthesia, but the control group did not. Surgical and anesthetic techniques were identical in both groups.<br />Results: Patient characteristics and surgical variables were similar in both groups (p value<0.05).<br />POAF was observed in 6 (8%) patients in the case group and in 18 (24%) of the controls.<br />There was a significant difference between the two groups in the prevalence of new-onset POAF (p value=0.03).<br />Conclusion: A preoperative dose of a combination of Digoxin, Hydrocortisone, and Amiodarone is a safe and feasible method to reduce POAF prevalence, produce a better outcome, and reduce the duration of hospital stay and hospital costs.