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To the Editor: In their randomized controlled trial of prophylactic amiodarone therapy for the prevention of atrial fibrillation after heart surgery, Dr Mitchell and colleagues¹ found that treatment with amiodarone compared with placebo resulted in a 48% reduction in the primary end point, defined as an atrial tachyarrhythmia lasting 5 minutes or longer that prompted treatment by the attending physician. We have a number of questions related to the study design and analysis.

First, the potential confounding effect of -blocker withdrawal was not considered.² Patients who have had treatment with a -blocker withdrawn have been found to have twice the likelihood of developing postoperative atrial fibrillation.³ In the present study, rates of -blocker use both before and after surgery were recorded, so withdrawal rates of -blockers could be derived and reported.

Second, the authors state that serum amiodarone levels were determined on the day of surgery but do not specifically . . . [Full Text of this Article]

Brian J. Potter, MD
brian.potter@umontreal.ca
Notre-Dame Hospital

Jacques LeLorier, MD, PhD, FRCPC
Centre de Recherche de l'Hôtel-Dieu du CHUM
Centre Hospitalier de l’Université de Montréal
Montréal, Quebec

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