Oral diltiazem as prophylactic treatment of arrhythmias in thoracic surgery

Abstract EN

Background : The perioperative management of patients with cardiac arrhythmias and conduction disturbances is an important task in patients undergoing thoracic surgery.

Objective : The evaluation of efficacy and safety of oral Diltiazem in prevention of postoperative atrial arrhythmias after major thoracic operations.

Patients and methods : A prospective, controlled, randomized clinical study from April 2000 to May 2002, design was used to study 120 patients who underwent elective major thoracic operations.

The patients were randomly distributed between two groups, the first group received oral diltiazem (60 mg / 8 hrs) starting 24 hours preoperatively and continued for one week postoperatively, while the second group was taken as a control group.

Continuous postoperative monitoring in the first 48 hours was done in the 1CU for evaluation of ECG, P02, arterial blood pressure and CVP.

Laboratory assessment of blood gases, serum sodium and potassium was done each hour.

Continuous clinical assessment of the patients was done to avoid hypotension, hypovolemia, hypoxia and / or hypokalemia.

Results : Demographic data were comparable.

In both groups, arrhythmias occurred mainly in the first 48 hrs postoperatively, which account for (86.2 %) of total incidence of arrhythmias.

Atrial fibrillation was the commonest recorded arrhythmia (46.66 %), followed by supraventricular tachycardia (30 %) and atrial flutter (10 %).

The highest incidence of arrhythmias occurred after pneumonectomy (8 / 19, 42.) %), followed by lobectomy (14 / 49, 28.57 %), mediastinal operations (4 / 19, 21.05 %) and decortication (3 / 16, 18.75 %), while no arrhythmias were recorded after both bullectomy and diaphragmatic hernia.

The incidence of atrial arrhythmias in diltiazem group was significantly lower than in the control group (11.67 % vs.

36.66 % respectively, P value < 0.01).

No serious side effects were reported in the diltiazem group.

Conclusions : Oral diltiazem is effective and safe as a prophylactic treatment against postoperative atrial arrhythmias in major thoracic surgery.