Anesthesiology Research and Practice / 2013 / Article / Tab 2

Review Article

Supraventricular Arrhythmias after Thoracotomy: Is There a Role for Autonomic Imbalance?

Table 2

Drug prophylaxis for postthoracotomy arrhythmias.

DrugStudy (ref. no.)Study typeNumber of patientsResultsStudy strength/weakness

Digoxin (see also studies [69, 70])Ritchie et al. 1990 [66]Unblinded
PRCT
Digoxin,
Control,
Incidence of arrhythmia
Digoxin 29/64 (45%)
Control 24/66 (36%)
NS
One death due to arrest in Digoxin group
Only 56.1% of patients underwent lung resection
No Holter monitoring
No sample size calculation
Ritchie et al. 1992 [67]Unblinded
PRCT
Digoxin,
Control,
Incidence of arrhythmia
Digoxin 29/58 (50%)
Control 19/53 (36%)
NS
No Holter monitoring
One death due to arrest
in Digoxin group

FlecainideBorgeat et al. 1989 [71]PRCTFlecainide,   
Placebo,
Outcome defined as
need to start or increase
antiarrhythmic drug
Flecainide 0/14
Placebo 6/16 (38%)
significant
Holter monitoring
small study
Borgeat et al. 1991 [69]PRCTFlecainide,   
Digoxin,
SVT or complex ventricular arrhythmia
Flecainide 1/15 (7%)
Digoxin 7/15 (47%)
significant
Holter monitoring,
small study
No placebo arm

Verapamil (see also study [74]) van Mieghem et al., 1996 [73]Unblinded
PRCT
Verapamil,   
Control,
Incidence of AF
Verapamil 8/100 (8%)
Control 15/99 (15%)
NS
No Holter monitoring
23% bradycardia or
hypotension in Verapamil group

Diliazem Amar et al. 1997 [70]Unblinded
PRCT
Diltiazem,   
Digoxin,
Incidence of AF
Diltiazem 5/35 (14%)
Digoxin 11/35 (31%)
NS
Low Diltiazem dose,
No placebo arm
Hypotension = 2 pts in Diltiazem group
2nd degree heart block = 1 in
Digoxin group
Amar et al. 2000 [18]Double-blinded
PRCT
Diltiazem,   
Control,
Incidence of AF
Diltiazem 25/167 (14%)
Control 40/163 (26%)
significant
Good study design, Holter monitoring,
sample size calculation,
comparable surgical interventions,
power analysis
3.59% in Diltiazem group
developed hypotension
(0.61% in control)

Amiodarone van Mieghem et al. 1994 [74] Retrospective review of prospectively collected data Amiodarone,   
No Amiodarone,
Incidence of AF
Amiodarone 1/32 (3.1%)
Verapamil 0/32 (0.0%)
Control 7/32 (21.8%)
(RCT report)
Study stopped early due to complications
High dose of Amiodarone
No Holter monitoring
3/32 pts developed ARDS
and 2/32 died in Amiodarone group (RCT report)
6/55 (11%) in Amiodarone
group versus 9/497 (1.8%) in control developed ARDS
(cohort report)
Lanza et al. 2003 [75]Retrospective cohort studyAmiodarone,   
control,
Incidence of AF 
Amiodarone 3/31 (9.7%) 
Control 17/52 (33%) 
Significant
No randomization
No Holter monitoring
Incidence of AF from records
Low dose of Amiodarone
Tisdale et al. 2009 [76]PRCTAmiodarone,   
control,
Incidence of AF
Amiodarone 9/65 (13.8%)
Control 21/65 (32.3%)
Significant
No Holter monitoring
Shorter ICU stay for Amiodarone group pts
No difference in complications
Riber et al. 2012 [77] Double-blinded-
PRCT
Amiodarone,   
Control,
Incidence of AF
Amiodarone 11/122 (9%)
Control 38/120 (31.6%)
significant
No side effects traced
to the prophylactic regime
Electrocardiogram or Holter monitoring,
power analysis,
intention to treat analysis

MagnesiumTerzi et al. 1996 [82]Unblinded
PRCT
Magnesium,   
Control,
Incidence of atrial
tachyarrhythmia
Magnesium 10/93 (11%)
control 27/101 (27%)
Significant
No Holter monitoring
No power analysis
Patients in control group received Digoxin