Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials

Harling, Leanne; Rasoli, Sonia; Vecht, Joshua A.; Ashrafian, Hutan; Kourliouros, Antonios; Athanasiou, Thanos

doi:10.1136/heartjnl-2011-300245

Cited by 55 publications

(37 citation statements)

References 34 publications

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“…In a recent meta-analysis including five randomized controlled trials with 567 patients, Harling et al [13] showed that the prophylactic use of vitamins C and E significantly reduced the incidence of POAF (OR: 0.43, 95% CI: 0.21 to 0.89) as well as the all-cause arrhythmia (OR: 0.54, 95% CI: 0.29 to 0.99) following cardiac surgery. However, the overall quality of enrolled studies was relatively poor.…”

Section: Vitamin C and Ementioning

confidence: 99%

Antioxidant Therapies in the Prevention and Treatment of Atrial Fibrillation

Liu¹,

Korantzopoulos²,

Li³

2013

Atrial Fibrillation - Mechanisms and Treatment

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Section: Vitamin C and Ementioning

confidence: 99%

Antioxidant Therapies in the Prevention and Treatment of Atrial Fibrillation

Liu¹,

Korantzopoulos²,

Li³

2013

Atrial Fibrillation - Mechanisms and Treatment

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“…It acts as an aqueous phase antioxidant that has the ability to stop the propagation of free radicals that cause lipid peroxidation, termed "chain breaking antioxidant", and is also required for the regeneration of the oxidised form of aTocopherol. 87 Studies in surgical and critically ill patients indicate an acute reduction in plasma vitamin C levels that is explained only partly by increased antioxidant demand in the tissues. 87 Levels are further decreased in patients that develop post-operative complications.…”

Section: Vitamin Cmentioning

confidence: 99%

“…87 Studies in surgical and critically ill patients indicate an acute reduction in plasma vitamin C levels that is explained only partly by increased antioxidant demand in the tissues. 87 Levels are further decreased in patients that develop post-operative complications. The well-established link between oxidative stress and atrial fibrillation (AF) studies has led investigators to assess the preventative effect of vitamin C supplementation (isolated or combination therapy) on the development of POAF.…”

Section: Vitamin Cmentioning

confidence: 99%

“…The well-established link between oxidative stress and atrial fibrillation (AF) studies has led investigators to assess the preventative effect of vitamin C supplementation (isolated or combination therapy) on the development of POAF. 87,88 Experimental and clinical evidence demonstrates a reduction in POAF following ascorbate supplementation. 89 A recent study demonstrated that the effect of vitamin C supplementation on POAF was more effective when given in association with ß-blockers compared to ß-blockers alone.…”

Section: Vitamin Cmentioning

confidence: 99%

“…Evidence is also emerging documenting that a reduction in POAF occurs after administration of the antioxidant vitamins C and E. 87,145 The trace element selenium is an essential component of at least 25 selenoproteins, which play a role in the cellular redox processes, and thus has been considered as the cornerstone of antioxidant defence. 247 One of the key seleno-enzymes in the antioxidant process is the enzyme glutathione peroxidase (GPx), which can be used as a surrogate marker for both selenium and oxidative stress status.…”

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confidence: 99%

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Selenium and oxidative stress modulation during extracorporeal circulation

McDonald¹

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Oxidative stress occurs when there is an imbalance between reactive oxygen and nitrogen species (RNOS) and the antioxidant system. In cardiac surgery patients and the critically ill there is an association between oxidative stress and morbidity and mortality.Extracorporeal circulation (ECC) encompasses cardiopulmonary bypass (CPB) which is used for cardiac surgery; extracorporeal membrane oxygenation (ECMO) which is used for cardio-respiratory support in the critically ill and haemodialysis which is used in patients with intermittent or end-stage renal failure.During ECC, the patient's total blood volume is in direct contact with an artificial surface for extended periods. In addition, there is often pre-existing inflammation, surgical trauma and/or ischemia-reperfusion (I-R) injury, all of which are major activators for the increased production of RNOS. Concurrent decreases in the level of essential antioxidants and trace elements (such as selenium, zinc and copper) occur, which upset redox balance in favour of oxidative stress. The trace element selenium is required for the normal function of the antioxidant enzyme glutathione peroxidase (GPx). Despite in vitro and biochemical data suggesting that reinforcement of antioxidant activity by selenium supplementation might reduce excessive oxidative stress damage, there is conflicting evidence in clinical studies.The reason for failure of antioxidant supplementation in the clinical setting is currently unclear.We postulated that the ECC and its associated interventions such as transfusion, might have a larger impact on trace element loss, antioxidant function and the oxidative stress response than previously recognised. This led to the following questions:  What is the selenium level in healthy Queensland residents, and is this level similar to that reported in other parts of the world? Does a patient's pre-CPB or pre-ECMO circulating selenium level influence their outcome? Does the ECC independently alter circulating selenium levels and the oxidative stress response? Do other interventions during ECC, such as transfusion, alter circulating selenium and oxidative stress levels?iii This thesis focussed on oxidative stress and the trace element selenium, because oxidative stress is associated with poorer outcomes in cardiac and critically ill patients, and decreased selenium is independently associated with poorer outcomes. To answer the research questions outlined above, a series of experiments were designed and conducted, and they generated the following new information.The average selenium level in a Queensland blood donor population was defined at 1.09 µmol/L (Chapter 3). In addition 88.5% of participants had a selenium level lower than the critical level required for maximal glutathione peroxidase activity, which has previously been determined to be between 1.14 -1.27 µmol/L. Furthermore, this study generated novel information that packed red blood cells and buffy coat pooled platelets have very low levels of selenium (≤ 0.3 µmol/L).The effect of car...

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Vitamin C for treating atrial fibrillation

Hemilä

Suonsyrjä

2015

Cochrane Database of Systematic Reviews

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Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials

Cited by 55 publications

References 34 publications

Antioxidant Therapies in the Prevention and Treatment of Atrial Fibrillation

Antioxidant Therapies in the Prevention and Treatment of Atrial Fibrillation

Selenium and oxidative stress modulation during extracorporeal circulation

Vitamin C for treating atrial fibrillation

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