Open AccessProphylactic amiodarone in patients with severe aortic stenosis and left ventricular hypertrophy undergoing aortic valve replacement: Silencing the rebels
Author(s) -
Mohammed Abd Al Jawad,
Mohammed S Shorbagy,
Mohamed Saleh
Publication year - 2017
Publication title -
journal of the egyptian society of cardio-thoracic surgery
Language(s) - English
Resource type - Journals
eISSN - 2524-1745
pISSN - 1110-578X
DOI - 10.1016/j.jescts.2017.12.001
Subject(s) - medicine , amiodarone , cardiology , defibrillation , aortic valve replacement , ventricular fibrillation , stenosis , sinus rhythm , anesthesia , aortic cross clamp , shock (circulatory) , cardioversion , atrial fibrillation , cardiopulmonary bypass
Background: Ventricular fibrillation occurs commonly after aortic cross clamp in patients undergoing aortic valve replacement for severe aortic stenosis. Amiodarone is a class III antiarrhythmic drug that can be used as a prophylactic measure to prevent reperfusion ventricular fibrillation as ventricular fibrillation increases myocardial oxygen demand and hence myocardial damage.Methods: A prospective, randomized, triple blinded study conducted in a single institution, Cardio-thoracic Academy, Ain –Shams University, Cairo, Egypt.120 patients with severe AS enrolled for elective aortic valve replacement. 60 patients received 10 ml of normal saline 9% (control group), while the other 60 patients received a single dose of Amiodarone 150 mg in 10 ml of Dextrose 5% through the pump circuit (Case Group). The incidence of post clamp arrhythmia, need of defibrillation, cardiac support was recorded.Results: 36 patients (60%) of the case group had spontaneous sinus rhythm upon declamping which is significantly lower than control group. The incidence of VF was lower in the case group (P value < 0.001) (highly significant). The number of DC shock required for ventricular defibrillation, total bypass and declamping times were significantly lower in the case group.Conclusions: Prophylactic use of a single dose amiodarone through the pump circuit before cross clamp release reduces the incidence of reperfusion induced ventricular fibrillation and subsequent defibrillation therapy needed