Atrial fibrillation is one of the most common complications after major thoracic (lung) operations. It is documented to increase hospital stay, patient morbidity and overall cost. The treatment of this cardiac arrhythmia has evolved over the last decade. Amiodarone is now the preferred pharmacologic therapy for this disorder. There have been several reports about its successful use for prophylaxis against post-operative atrial fibrillation. This led to our interest in using this drug prophylactically in our high risks patients.

From November 1, 2006 through May 31, 2007 (Period 1), a total of 92 lung resection procedures were performed. These included 32 lobectomies, 52 wedge resections and eight pneumonectomies. Atrial fibrillation occurred in eight cases: three pneumonectomies and five lobectomies.

• Post-lobectomy atrial fibrillation rate – 15.6%
• Post-pneumonectomy atrial fibrillation rate – 37.5%

At the end of May 2007, a prophylactic amiodarone protocol was instituted for all patients undergoing pneumonectomies and for those 75 years or older undergoing lobectomies. From June 1, 2007 through September 30, 2007 (Period 2), a total of 62 lung resection procedures were performed. These included 43 lobectomies, 12 wedge resections and seven pneumonectomies. Atrial fibrillation occurred in three cases: one pneumonectomy case and two lobectomy cases.

• Post-lobectomy atrial fibrillation rate declined to 4.7% (down from 15.6%), which is a 70% reduction in incidence.
• Post-pneumonectomy atrial fibrillation rate declined to 14.3% (down from 37.5%), which is a 62% reduction in incidence.