| English |
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| Title | Efficacy of Continuous Infusion of Disopyramide or Verapamil in the Management of Intractable Atrial Fibrillation after Cardiac Surgery |
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| Subtitle | |
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| Authors | Shingo Ogino, Shigeyuki Sasaki, Kenichiro Aoi, Hisashi Sugimoto, Shigeaki Kobayashi, Satoshi Gando, Osamu Kemmotsu |
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| Authors(kana) | |
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| Organization | Division of Intensive Care Unit, Hokkaido University Hospital |
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| Journal | Circulation Control |
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| Volume | 19 |
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| Number | 2 |
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| Page | 261-266 |
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| Year/Month | 1998/ |
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| Article | Original article |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | [Abstract] Background and Purpose. Atrial fibrillation (Af) after cardiac surgery is one of the most common sustained arrhythmias. Among these patients with postoperative Af, some patients have an intractable Af refractory to a routine treatment. We examined the efficacy of continuous infusion of disopyramide or verapamil in the management of the intractable Af. Patients and Methods. Nine patients (8 males and 1 female, the mean age of 69.8±2.6) who developed an intractable Af after cardiac surgery refractory to diltiazem were studied. Five of nine patients received continuous infusion of disopyramide (group D) and four patients received continuous infusion of verapamil (group V). Patients were continuously monitored with a two-channel (II and V5 leads) ECG with Holter function (M2360A) during surgery and the postoperative period. Changes in cardiac index, corrected QT (QTc) intervals (group D), and other routine hemodynamic variables were assessed. The incidence of return to sinus rhythm and the requirement of vasoconstrictors was compared between the two groups. Therapeutic drug monitoring (TDM) was performed for patients in group D. Results. The incidence of return to sinus rhythm was significantly higher (p<0.05) in group D (5/5) than in group V (1/4). The mean plasma concentration of disopyramide at the time of return to sinus rhythm was 2.2±0.1μg/ml, which was well consistent with previous reports. There was no remarkable side effect in group D. Hemodynamic deterioration during the continuous infusion of antiarrhythmic agents was generally mild in group D, but was often severe in group V. The incidence of epinephrine requirement was significantly higher in group V (4/4) than in group D (0/5 ; p<0.01). Conclusions. Continuous infusion of disopyramide is more beneficial for the intractable Af than verapamil, in view of the efficacy on return to sinus rhythm and the severity of negative inotropic action. Continuous infusion of disopyramide is also a promising therapeutic option that can be preferentially employed for the post-cardiotomy intractable Af refractory to a routine treatment. TDM of disopyramide associated with a computer-generated arrhythmia trendgram contributed to establishing the validity of the therapeutic approach. |
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| Practice | Basic medicine |
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| Keywords | Atrial fibrillation, Postoperative complication, Disopyramide, Verapamil, Antiarrhythmic therapy, Therapeutic drug monitoring (TDM) |
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