Pragmatic Amiodarone Trial to Reduce Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

The occurrence of postoperative atrial fibrillation detected by continuous telemetry, 12-lead electrocardiogram, and/or continuous ambulatory monitoring device through postoperative day 7.

Operative mortality as defined by either in-hospital death or death within 30 days of discharge.

characterized by deficits lasting > 24 hours and/or imaging findings of infarction

characterized by examination findings lasting < 24 hours without associated imaging findings

Whether the patient required electrical cardioversion for hemodynamically unstable atrial fibrillation

New hemodynamic instability (mean arterial pressure < 65 mmHg) after surgery

New indication of systemic anticoagulation for stroke prophylaxis due to atrial fibrillation

Myocardial infarction diagnosed based on ECG and laboratory testing including pursued intervention and/or findings from subsequent angiography will be compared between intervention groups. To be considered a myocardial infarction, the diagnosis will have to be confirmed and documented in the chart by a board-certified cardiologist.

Atrial fibrillation as diagnosed by final ECG

The postoperative length of stay will be calculated starting from the end of the procedure to time of discharge.

Rates of hospital readmission will be estimated for patients in each of the study intervention groups. Readmissions will be counted in this calculation if patients are admitted to the hospital. Emergency room visits without admission and outpatient visits will not count toward this calculation of readmission rates.

Symptomatic bradycardia (HR < 55 bpm) requiring intervention

Clinical diagnosis of amiodarone-related pulmonary toxicity that uses a combination of x-ray findings consistent with known amiodarone-related pulmonary toxicity and clinical findings including shortness of breath, non-productive cough, and other diagnoses have been excluded.