Efficacy of Nonsteroidal Anti‐Inflammatory Medications for Prevention of Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery

Abstract

This study was designed to test whether nonsteroidal anti-inflammatory medications could reduce the frequency of atrial fibrillation after coronary artery bypass graft surgery. The study was designed as an open-label, randomized trial. Patients undergoing first-time coronary artery bypass graft surgery were considered eligible. Patients with a history of atrial fibrillation, serum creatinine >2.0 mg/dL, on antiarrhythmic treatment, and those undergoing concomitant valvular surgery were excluded. The study was conducted in a single, university-affiliated community hospital. The researchers' role in the study was restricted to randomizing the patients and collecting data. The primary clinical care team made all decisions regarding patient care. One hundred patients were randomized to two groups: one received 30 mg ketorolac intravenously every 6 hours until able to take oral medications, at which point the patients were switched to 600 mg ibuprofen orally three times a day; the other group received conventional treatment. The primary end point of the study was incidence of atrial fibrillation in the immediate postoperative period. Atrial fibrillation occurred in 14 patients (28.6%) in the conventional treatment group vs. five patients (9.8%) in the ibuprofen group (p<0.017). Nonsteroidal anti-inflammatory medications were relatively safe and effective in significantly reducing the incidence of atrial fibrillation after coronary artery bypass graft surgery.

Systemic vascular cell adhesion molecule-1 predicts the occurrence of post-operative atrial fibrillation

“…Other factors associated to POAF in the literature include history of chronic obstructive pulmonary disease, heart failure, diabetes mellitus, valvulopathy, withdrawal of ACE inhibitors or beta-blockers [2,47] and obesity [48]. In contrast, preoperative use of statins [49,50], beta-blockers [51], amiodarone [52] and anti-inflammatory agents [53,54] has been associated with a reduced incidence of POAF. However, it is still controversial whether these interventions impact significantly on the perioperative complications derived from atrial fibrillation and whether these benefits outweigh the potential risk associated to its use [7].…”

Possible arrhythmiogenic mechanism produced by ibuprofen

“…On the contrary, some reports indicate that NSAIDs, such as salicylic acid (SA), can reduce ventricular dysfunction and arrhythmias [16][17][18] . The investigators proposed that ibuprofen could prevent the atrial fibrillation mediated by inflammation, and SA could trap the hydroxyl radicals to reduce postischemic ventricular arrhythmias.…”

Review: Beyond the Guidelines: New and Novel Agents for the Prevention of Atrial Fibrillation After Cardiothoracic Surgery

“…Data from retrospective studies as well as RCTs indicate that NSAIDs are effective at reducing the risk of POAF by as much as 65%, although adequate numbers of patients have not been studied to determine their impact on LOS and stroke, nor to fully evaluate the safety of these agents following cardiothoracic surgery. 54,55 A prospective, nested cohort study of 555 patients from the Atrial Fibrillation Suppression Trials (AFIST) I, II, and III demonstrated that the incidence of POAF was significantly reduced in patients who receive NSAIDs postoperatively (adjusted odds ratio [AOR] 0.54, 95% CI 0.32-0.90; P ¼ .02) in a multivariate analysis. No significant effects on stroke (AOR 1.10, 95% CI 0.21-5.66) or myocardial infarctions (AOR 1.70, 95% CI 0.40-7.10) were seen, although few events occurred.…”