A comparative study between amiodarone and magnesium sulfate as antiarrhythmic agents for prophylaxis against atrial fibrillation following lobectomy

Purpose: Atrial fibrillations are common after thoracic surgery. Amiodarone and magnesium sulfate have been used for the management of atrial fibrillation following cardiac and non-cardiac surgery. However, to our knowledge, comparisons of both drugs with each other and with a control group in relation to the prevention of AF following lung surgery have not been performed. Our primary aim in this study was to prospectively evaluate the prophylactic effects of magnesium sulfate and amiodarone used separately and compare them with a control group analyzed retrospectively during and following lobectomy surgeries. Patients and methods: The prophylactic value of amiodarone (group A; 219 patients) administered as an intravenous infusion (15 mg/kg for 48 h postoperatively) after a loading dose (5 mg/kg) was compared with magnesium sulfate (group M; 219 patients) administered intravenously as a loading dose (80 mg/kg magnesium sulfate over 30 min preoperatively) and then as an intravenous infusion (8 mg/kg/h for 48 h) in 438 patients undergoing lobectomy. These two groups were compared with a control group of 219 patients who were analyzed retrospectively. Results: The results showed significantly lower incidences of AF in groups A and M when compared with group C (P < 0.05). There was no significant difference between the amiodarone and magnesium sulfate groups. However, the incidence of postoperative AF was lower in the amiodarone group, where only 21 (10 %) patients developed AF in comparison to 27 (12.5 %) patients in the magnesium sulfate group. Group C showed a higher incidence, 44 (20.5 %) patients, when compared with both groups. In addition, there were significant differences between the three groups concerning intensive care unit (ICU) and total hospital stays (P < 0.05). Conclusion: Our study showed that during the intra- and postoperative periods, both amiodarone and magnesium sulfate are effective at preventing the incidence of atrial fibrillation following lung resection surgery in comparison to the control group.