Effect of Amiodarone Duration on Postoperative Atrial Fibrillation in Noncardiac Surgery Patients

Introduction: Postoperative atrial fibrillation (POAF) is a common complication following non-cardiothoracic surgery, typically occurring within the first two postoperative days. POAF is associated with greater risks of stroke, myocardial infarction, and mortality. Amiodarone is commonly used to manage POAF; however, guidance on optimal duration and dosing is limited for patients without cardiac history undergoing non-cardiothoracic surgery. This study evaluates whether short-term amiodarone therapy, less than 48 hours, is associated with similar recurrence rates and improved clinical outcomes compared to extended durations, greater than 48 hours.


Methods: This retrospective, single-center study at a Level 1 trauma and academic medical center included non-cardiothoracic surgery POAF patients in the Surgical Intensive Care Unit (SICU). The primary endpoint is the rate of atrial fibrillation (AF) recurrence within 14 days of original AF resolution for patients who received amiodarone for < 48 hours compared to ≥48 hours. Patients admitted to the SICU with a diagnosis of POAF who received amiodarone treatment were included. Cardiothoracic and endovascular surgery patients or those with a history of arrhythmias on medical therapy were excluded.


Results: The study enrolled 115 patients, 80 in the ≥48-hour group and 35 in the < 48-hour group. Patients had a mean age of 66 years; 66% were male, 57.3% underwent general surgery, and 21.7% were trauma patients. The rate of atrial fibrillation recurrence was lower in the group receiving amiodarone for < 48-hours, (14.3% vs. 50%, P < 0.001). No significant difference was found in time to initial AF episode resolution (7.3 h vs. 6.2 h; P = 0.97) or duration of AF (7.5 h vs. 6.8 h; P = 0.78). Anticoagulant use was higher in the ≥48-hour group, though thrombotic events did not differ significantly (5.7% vs. 12.5%; P = 0.34). Patients in the ≥48-hour group were more likely to be discharged on amiodarone (2.9% vs. 51.2%, P < 0.001).


Conclusions: The use of amiodarone for < 48-hours was associated with decreased rates of AF recurrence and had similar rates of AF resolution compared to the ≥ 48-hour group for POAF following non-cardiothoracic surgery. Further research is warranted to determine the ideal treatment duration of antiarrhythmics and long-term recurrence risk.