Effect of low-dose amiodarone and magnesium combination on atrial fibrillation after coronary artery surgery

Background: To evaluate whether postoperative administration of intravenous low-dose amiodarone and magnesium sulfate (MgSO4) combination would reduce the incidence of atrial fibrillation following coronary artery bypass grafting (CABG) in normomagnesemic high-risk patients for postoperative atrial fibrillation (POAF). Methods: A total of 136 patients undergoing elective CABG and had >= 3 risk factors for POAF were prospectively randomized to one of three groups, to receive a single dose of amiodarone (5 mg/kg) and MgSO4 (1.5 g) (combination group, n=44), or an equal dose of amiodarone (amiadorone group, n=44) or equal volumes of saline (control group, n=48) at early postoperative period. Continuous electrocardiographic (ECG) monitorization was performed for first 48 hours and an ECG was recorded every 8 hours later. POAF longer than 30 minutes or for any length requiring treatment, and the drug-related side effects were recorded. Results: The study population showed a homogeneous distribution regarding risk factors for POAF and there was no significant difference in patient characteristics, echocardiographic variables, or operative variables among three groups. POAF developed in 4 patients in combination group, in 16 patients in amiodarone group and in 16 patients in control group, representing a 24% relative risk reduction between the combination group and control group (p=0.023). No statistically significant difference regarding incidence of POAF was observed between amiodarone and control groups. Conclusions: Combined prophylactic therapy with amiodarone and MgSO4 at the early postoperative period without a maintenance phase is an effective, simple, well-tolerated, and possibly cost-effective regimen to prevent POAF in normomagnesemic, high-risk patients.