Effects of Diltiazem Prophylaxis on the Incidence and Clinical Outcome of Atrial Arrythmias after Thoracic Surgery

• Main Authors: Amar, D., Roistacher, N., Rusch, V. W., Leung, Denis H. Y., Ginsburg, I., Zhang, H., Bains, M. S., Downey, R. J., Korst, R., Ginsberg, R.J.
• Format: text
• Language: English
• Published: Institutional Knowledge at Singapore Management University 2000
• Subjects: Econometrics; Medicine and Health Sciences
• Online Access: https://ink.library.smu.edu.sg/soe_research/83
• Institution: Singapore Management University

We sought to determine whether early prophylaxis with an L-type calcium channel blocker reduces the incidence and morbidity associated with atrial fibrillation/flutter and supraventricular tachyarrhythmia after major thoracic operations.Methods: In this randomized, double-blind, placebo-controlled study, 330 patients were given either intravenous diltiazem (n = 167) or placebo (n = 163) immediately after lobectomy ([>=]60 years) or pneumonectomy ([>=]18 years) and orally thereafter for 14 days. The primary end point with respect to efficacy was a sustained ([>=]15 minutes) or clinically significant atrial arrhythmia during treatment.Results: Postoperative atrial arrhythmias (atrial fibrillation/flutter = 60; supraventricular tachyarrhythmias = 5) occurred in 25 (15%) of the 167 patients in the diltiazem group and 40 (25%) of the 163 patients in the placebo group (P = .03). When compared with placebo, diltiazem nearly halved the incidence of clinically significant arrhythmias (17/167 [10%] vs 31/163 [19%], P = .02). The 2 groups did not differ in the incidence of other major postoperative complications or overall duration or costs of hospitalization. No serious adverse effects caused by diltiazem were seen.Conclusions: After major thoracic operations, prophylactic diltiazem reduced the incidence of clinically significant atrial arrhythmias in patients considered at high risk for this complication.