Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery

J Thorac Cardiovasc Surg. 2000 Oct;120(4):790-8. doi: 10.1067/mtc.2000.109538.

Abstract

Objectives: We sought to determine whether early prophylaxis with an L -type calcium channel blocker reduces the incidence and morbidity associated with atrial fibrillation/flutter and supraventricular tachyarrhythmia after major thoracic operations.

Methods: In this randomized, double-blind, placebo-controlled study, 330 patients were given either intravenous diltiazem (n = 167) or placebo (n = 163) immediately after lobectomy (> or =60 years) or pneumonectomy (> or =18 years) and orally thereafter for 14 days. The primary end point with respect to efficacy was a sustained (> or =15 minutes) or clinically significant atrial arrhythmia during treatment.

Results: Postoperative atrial arrhythmias (atrial fibrillation/flutter = 60; supraventricular tachyarrhythmias = 5) occurred in 25 (15%) of the 167 patients in the diltiazem group and 40 (25%) of the 163 patients in the placebo group (P = .03). When compared with placebo, diltiazem nearly halved the incidence of clinically significant arrhythmias (17/167 [10%] vs. 31/163 [19%], P = .02). The 2 groups did not differ in the incidence of other major postoperative complications or overall duration or costs of hospitalization. No serious adverse effects caused by diltiazem were seen.

Conclusions: After major thoracic operations, prophylactic diltiazem reduced the incidence of clinically significant atrial arrhythmias in patients considered at high risk for this complication.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Administration, Oral
  • Aged
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / prevention & control*
  • Atrial Flutter / epidemiology
  • Atrial Flutter / prevention & control*
  • Calcium Channel Blockers / therapeutic use*
  • Diltiazem / therapeutic use*
  • Double-Blind Method
  • Female
  • Hospital Costs
  • Humans
  • Incidence
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control*
  • Pulmonary Surgical Procedures
  • Tachycardia, Supraventricular / epidemiology
  • Tachycardia, Supraventricular / prevention & control*
  • Treatment Outcome

Substances

  • Calcium Channel Blockers
  • Diltiazem