Details

Autor(en) / Beteiligte

• Hochreiter, Marcel
• Schmidt, Thomas
• Siegler, Benedikt H.
• Sisic, Leila
• Schmidt, Karsten
• Bruckner, Thomas
• Müller-Stich, Beat P.
• Diener, Markus K.
• Weigand, Markus A.
• Büchler, Markus W.
• Busch, Cornelius J.

Titel

Diltiazem Prophylaxis for the Prevention of Atrial Fibrillation in Patients Undergoing Thoracoabdominal Esophagectomy: A Retrospective Cohort Study

Ist Teil von

• World journal of surgery, 2020-07, Vol.44 (7), p.2295-2304

Ort / Verlag

Cham: Springer International Publishing

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Atrial fibrillation (AF) represents the most frequent arrhythmic disorder after thoracoabdominal esophageal resection and is associated with a significant increase in perioperative morbidity and mortality. Methods In this retrospective cohort study, 167 patients who underwent thoracoabdominal esophagectomy at a large university hospital were assessed. We compared patients who received a 14-day postoperative course of diltiazem with a control group of patients who did not undergo diltiazem prophylaxis. Diltiazem therapy started immediately upon admission to the intensive care unit (ICU) with a loading dose of 0.25 mg/kg bodyweight (i.v.) followed by continuous infusion (0.1 mg/kg bodyweight/h) for 40–48 h. Oral administration (Dilzem ® 180 mg uno retard, once a day) was started on postoperative day 3. Results A total of 117 patients were assessed. Twelve (10.3%) of all patients developed postoperative new-onset atrial fibrillation in the first 30 days after surgical intervention. Prevalence of new-onset AF showed no significant differences between the diltiazem group and control group ( p  = 0.74). The prevalence of bradycardia (14.7% vs. 3.6%; p  = 0.03) and dose of norepinephrine required (0.09 vs. 0.04 µg/kg bodyweight/min; p  = 0.04) were higher in the diltiazem group. There were no significant differences between the groups for the median postoperative duration of hospital/ICU stay or mortality. Conclusions A prophylactic 14-day postoperative course of diltiazem was not associated with a reduction in new-onset AF or 30-day mortality following thoracoabdominal esophagectomy. Prophylactic diltiazem therapy was associated with drug-related adverse effects such as bradycardia and increased requirement of norepinephrine. German Clinical Trial Registration Number: DKRS00016631.