Accepted Manuscript Effectiveness of Biatrial Epicardial Application of Amiodarone Releasing Adhesive Hydrogel to Prevent Postoperative Atrial Fibrillation William Wang , Xiao Dong Feng , Xue Ning Wang , Xin Hiu Yuan PII:

S0022-5223(14)00593-5

DOI:

10.1016/j.jtcvs.2014.05.049

Reference:

YMTC 8634

To appear in:

The Journal of Thoracic and Cardiovascular Surgery

Received Date: 28 March 2014 Revised Date:

15 May 2014

Accepted Date: 19 May 2014

Please cite this article as: Wang W, Feng XD, Wang XN, Yuan XH, Effectiveness of Biatrial Epicardial Application of Amiodarone Releasing Adhesive Hydrogel to Prevent Postoperative Atrial Fibrillation, The Journal of Thoracic and Cardiovascular Surgery (2014), doi: 10.1016/j.jtcvs.2014.05.049. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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ACCEPTED MANUSCRIPT

Effectiveness of Biatrial Epicardial Application of Amiodarone Releasing

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Adhesive Hydrogel to Prevent Postoperative Atrial Fibrillation

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William Wang , Xiao Dong Feng , Xue Ning Wang , Xin Hiu Yuan 1

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Scripps Memorial hospital, La Jolla, CA ; Shanghai Eastern Hospital, Shanghai, China ; ShanXi 3

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Cardiovascular Hospital, TaiYuan , Shanxi, China; Changzhi Peace Hospital, Changzhi,Shanxi, China

William Wang, M.D. 9850 Genesee Ave. Suite 560, La Jolla CA 92037

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Tel: (858) 626-6348, Fax: (858) 455-4590, Email: [email protected]

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3540

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ACCEPTED MANUSCRIPT

Objective: Postoperative atrial fibrillation (POAF) is the most frequent complication arising after cardiac surgery, occurring in 30% of cases. Amiodarone is the most effective drug for prophylaxis and treatment.

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However, because of significant extracardiac side effects, only high-risk patients are eligible for prophylactic amiodarone therapy. We performed a randomized prospective study in 100 patients

undergoing cardiac surgery with epicardial application of amiodarone-releasing hydrogel to determine the

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effectiveness of preventing POAF.

Methods: After Institutional Review Board approval, 100 patients from January 2012 to July 2013 who

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underwent cardiac surgery were randomized into 2 equal groups. The study group had poly based hydrogel with amiodarone sprayed diffusely over the epicardium. The control group underwent the procedure without implementing the spray. Continuous telemetry monitored for POAF and amiodarone levels in the atria, plasma and tissue were measured postoperatively. Daily EKG parameters were

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measured until postoperative day 14.

Results: The incidence of POAF was significantly less in the study group with 4 of 50 patients (8%) incurring atrial fibrillation compared with 13 of 50 patients (26%) in the control group (P < .01). Mean

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amiodarone concentrations in the atria (12.06±3.1) were significantly higher than in extra cardiac tissues (1.32±0.9)(p < 0.01). Plasma amiodarone levels remained below the detection limit (30 21 (42%) 19 (38%) 40 NS β-Blockers 11(22%) 14 (28%) 25 NS Calcium channel blockers 5 (10%) 7 (14%) 12 NS Aspirin 31(62%) 37 (74%) 65 NS MI, myocardial infarction; CHF, congestive heart failure; IABP, Intra-aortic balloon pump; CABG, Coronary artery bypass graft surgery; PCI, Percutaneous coronary intervention; PVD, Peripheral vascular disease. AF, Atrial fibrillation