Preventing new onset atrial

fibrillation following

CABG
Katelyn E. Esposito, BSN, RN
Capstone Presentation
NURS 7005
Atrial Fibrillation
Atrial fibrillation is defined as a supraventricular
arrhythmia characterized by erratic atrial
depolarizations, leading to disorganized, ineffective
atrial contractions and variable atrial ventricular
nodal conduction, which results in and irregular
ventricular rate.
 Prevalence of A Fib

20% - 40%

• Atrial Fibrillation occurs in 20% - 40% of patients who undergo CABG.

• Increases risk of stroke and hemodynamic instability and increased length of

stay
 Risk Factors

COPD OBESITY HYPERTENSION

> 15 million adults in the 42.4% of adults in the United > 122 million adults in the
United States States United States

ADVANCED AGE MYOCARDIAL HEART FAILURE

> 46 million ISCHEMIA 6.2 million adults in the
United States
805,000 Americans yearly
• Incidence of this arrhythmia has not changed despite improvements in
surgical and anesthetic techniques, and evidence suggests its increase
may be rising.

• Currently, there is no consistent, evidence based system for

stratification of patients in different risk groups.

• Although often harmless and self limiting; A Fib following CABG

requires additional treatment, nursing time, increased length of stay,
increased risk of stroke and the possibility of hemodynamic
compromise
To Treat? – Or not no treat?
 The Question
In patients who undergo coronary artery bypass
grafting, does prophylactic amiodarone eliminate or
decrease the occurence of atrial fibrillation versus not
prophylactically treating with amiodarone?
 Objectives

To determine if prophylactic To obtain updated research data

amiodarone decreased the incidence
of post op A Fib 01 02 studying the incidence of post op A
Fib in different patient groups

To develop and present a

presentation on the data collected
03 04 To collect data on patients who underwent
CABG at TRMC and compare the
incidence of post operative A Fib
 Prevention
Many different pharmacologic agents and surgical strategies have been
studied for preventing the development of of A Fib after CABG

Magnesium Potassium Beta Blockers Sotalol

 Amiodarone
• Amiodarone has predominately potassium channel-blocking antiarrhythmic properties, but
also exhibits some degree of action at the beta-adrenergic receptor, sodium and calcium
channels.
• Adverse Reactions: bradycardia, hypotension, potential pulmonary, hepatic and thyroid
toxicity; although rarely with short-term use.
• 2013 meta-analysis found a significant reduction in atrial fibrillation after cardiac surgery.
• There was also a reduction in length of stay, although no decrease in mortality.
• Amiodarone receives a Class IIa recommendation by the ACC/AHA/HRS and the
SCA/EACTA Practice Advisory for AF prophylaxis.
 Trumbull Regional Medical Center

Non- Prophylactic Group

16 patients
66 patients studied
Too slowly
50 received prophylaxis
16 did not receive prophylaxis
Prophylactic Group
50 patients
 Research Conclusions
#1 #2 #3
Amiodarone Amiodarone Amiodarone
Was associated with a lower Was well tolerated and Did not statistically alter the
risk of atrial arrhythmia and significantly reduces the incidence or duration of Afib
shorter LOS. incidence of Afib after CABG

#4 #5
Amiodarone Amiodarone
Reduces ventricular rate and Decreased the incidence of A
duration of atrial fibrillation Fib and displayed lower
after CABG mortality
 Atrial Fibrillation is the most common
adverse event after cardiac surgery
• Significant Morbidity
• Mortailty
• Resource Use
• Cost
• Current Data does not demonstrate
significant and consistent enough results
to develop evidence based guidelines.

• Prophylactic use of Amiodarone proves to

improve outcomes and does not
demonstrate harm in the majority of
research trials.
The Future of A
Fib
It is my hope that as medical professionals and research collectors, we
continue to study this area of medicine in order to provide improved
patient outcomes and use of less resources and man-power to accomplish
this goal.
Thank you for
your time.
Please complete the following course
evaluation questions prior to your
departure.
Course Evaluation
1. Was the material presented in a clear and concise manner?

2. Was the course content free of bias?

3. Did this material provide practical application to use in your work?

4. Was there something new you learned from this material?

5. Are there any areas where you feel the material could have been improved
on / expanded on?
 References
Ahmed, M.A., Ghoneim, A.E., Wahab, A.B., (2022). Does prophylactic low-dose amiodarone decrease the incidence of postoperative atrial
fibrillation after coronary artery bypass graft surgery. The Cardiothoracic Surgeon (Vol. 30, Issue 1)
http://dx.doi.org.eps.cc.ysu.edu/10.1186/s43057-022-00085-4

Alaeddini, F., Mandegar, M.H., Roshanali, F., Saidi, B., Yousefnia, A.M., (2021). Prevention of atrial fibrillation after coronary artery bypass
grafting via atrial electromechanincal interval and use of amiodarone prophylaxis. Interactive Cardiovascular and Thoracic Surgery
(8) 421-425. doi:10.1510/icvts.2008.191403

Atreya, A. R., Priya, A., Pack, Q. R., Pekow, P. S., Stefan, M., Lagu, T., Lotfi, A. S., & Lindenauer, P. K. (2019). Use and outcomes
associated with perioperative amiodarone in cardiac surgery. Journal of the American Heart Association, 8(15). Retrieved March 21, 2022,
from https://doi.org/10.1161/jaha.118.009892

Baranchuk, A., Chen, X., El-Diasty, M., Fernandez, A.L., Ross-White, A., Sartor, C., Zhang, S., Effectiveness of intra-operative topical
amiodarone for prevention of postcardiac surgery new-onset atrial fibrillation: A review of current evidence. (2022) Journal of
cardiac surgery. Dec; Vol.37 (12), pp. 5371-2378. https://doi.org.10.1111/jocs.17190

Daoud, E. G., Strickberger, S., Man, K., Goyal, R., Deeb, G., Bolling, S. F., Pagani, F. D., Bitar, C., Meissner, M. D., & Morady, F. (1997).
Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. New England Journal of Medicine,
337(25), 1785–1791. Retrieved March 21, 2022, from https://doi.org/10.1056/nejm199712183372501
 References
(con’t)
Matos, J. D., McIlvaine, S., Grau-Sepulveda, M., Jawitz, O. K., Brennan, J., Khabbaz, K. R., Sellke, F. W., Yeh, R., & Zimetbaum, P. (2021).
Anticoagulation and amiodarone for new atrial fibrillation after coronary artery bypass grafting: Prescription patterns and 30- day
outcomes in the united states and canada. The Journal of Thoracic and Cardiovascular Surgery, 162(2), 616–624.e3.
https://doi.org/10.1016/j.jtcvs.2020.01.077

Redle, J. D., Khurana, S., Marzan, R., McCullough, P. A., Stewart, J. R., Westveer, D. C., O'Neill, W. W., Bassett, J. S., Tepe, N. A., & Frumin,
H. I. (1999). Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass
surgery. American Heart Journal, 138(1), 144–150.

Redle, J. D., Khurana, S., Marzan, R., McCullough, P. A., Stewart, J. R., Westveer, D. C., O'Neill, W. W., Bassett, J. S., Tepe, N. A., &
Frumin, H. I. (1999). Prophylactic oral amiodarone compared with placebo for prevention of atrial fibrillation after coronary artery bypass
surgery. American Heart Journal, 138(1), 144–150. https://doi.org/10.1016/s0002-8703(99)70260-7

Baranchuk, A., Chen, X., El-Diasty, M., Fernandez, A.L., Ross-White, A., Sartor, C., Zhang, S., Effectiveness of intra-operative topical
amiodarone for prevention of postcardiac surgery new-onset atrial fibrillation: A review of current evidence. (2022) Journal of cardiac
surgery. Dec; Vol.37 (12), pp. 5371-2378. https://doi:10.1111/jocs.17190
 Thanks!

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