A comparison of amiodarone and digoxin for treatment of supraventricular arrhythmias after cardiac surgery

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Abstract
Despite the widespread use of amiodarone in non-surgical patients, itsrole in the management of supraventricular tachyarrhythmias after cardiacsurgery is not clear. We set out to compare the relative efficacy ofamiodarone and digoxin in the management of atrial fibrillation and flutterin the early postoperative period. This prospective randomised trialcomprised 30 patients, previously in sinus rhythm, who developed sustainedatrial fibrillation or flutter following myocardial revascularisation,valve surgery or combined procedures. Amiodarone was administered as anintravenous loading dose followed by a continuous infusion. Digoxin wasgiven as an intravenous loading dose followed by oral maintenance therapy.Electrocardiographic and haemodynamic monitoring was continued for 24 hafter the commencement of treatment. There was a marked reduction in heartrate in both groups, mainly in the first 6 h, from 146 to 89 beats perminute in the amiodarone group and from 144 to 95 in the digoxin group. Atthe end of the 24 h, one of the 15 patients in the amiodarone group and 3of the 15 patients in the digoxin group remained in atrial fibrillation. Nopatient in either group developed adverse reactions. We conclude thatintravenous amiodarone therapy is safe and at least as effective as digoxinin the initial management of arrhythmias after cardiac surgery.

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