The Effects of Melatonin on the Oxidative Stress and Duration of Atrial Fibrillation after Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial

Abstract

Background: Atrial Fibrillation (AF) is a common complication following Coronary artery bypass graft (CABG) Surgery, which may be due to oxidative stress, necrosis and inflammation during CABG and can lead to increases the length of hospital stay and the risk of morbidity and mortality. Melatonin is a hormone with anti-oxidant and anti-inflammatory properties in the cardiovascular system. This study assessed the efficacy of sublingual consumption of melatonin in reducing necrosis and inflammation, in patients undergoing CABG with respect to C-reactive protein (hs-CRP), Creatine KinaseMuscle-Brain subunits (CK-MB) and cardiac Troponin T (cTnT) levels. Methods: One hundred and two patients were enrolled and twenty-six patients were excluded during the study process and finally seventy-six patients undergoing CABG surgery randomly assigned to melatonin group (n = 38, 12 mg sublingual melatonin the evening before and 1 hour before surgery, or the control group which did not receive Melatonin, n = 38). Three patients in the melatonin group and three patients in the control group were excluded from the study because of discontinued intervention and lost to follow up. The samples were collected before and 24 hours after surgery. hs-CRP, CKMB, and cTnT levels were measured in all patients with the Elisa method. Results: There was no significant difference in influencing variables among the groups at the baseline. The incidence of AF following CABG surgery was not statistically significant between the two groups, (p value = 0.71). However, the duration of AF (p value = 0.01), the levels of hs-CRP (p value = 0.001) and CK-MB (p value = 0.004) measured, 24 hours after surgery were significantly lower in the melatonin group. cTnT levels measured 24 hours post-CABG did not show any significant difference in both groups (p value = 0.52). Conclusion: Our findings suggest that the administration of melatonin may help modulate oxidative stress, based on the reduction of the levels of hs-CRP, CK-MB, and the duration of AF following CABG surgery.

Combined Melatonin and Extracorporeal Shock Wave Therapy Enhances Podocyte Protection and Ameliorates Kidney Function in a Diabetic Nephropathy Rat Model

“…SW therapy mechanisms of various diseases have been published, including increase of anti-inflammation [17,18,20,43,44] and anti-oxidative stress [17,18,20,45]. The mechanisms of Mel therapy in various diseases have also been published, including increase of anti-oxidative stress [15,[46][47][48][49][50] and anti-inflammation [50][51][52][53]. Based on our findings, the proposed mechanisms of Mel combined SW therapy on DN are summarized in Figure 8.…”

“…Melatonin (Mel) is mainly secreted by the pineal gland and has a renal protective effect [12]. Mel has been found to be a powerful antioxidant used to inhibit oxidative stress and the production of active oxidative substances [12][13][14][15]. Mel also has anti-inflammatory properties [12,13].…”

Melatonin increases susceptibility to atrial fibrillation in obesity via Akt signaling impairment in response to lipid overload

“…MLT has been reported to have antiarrhythmic potential, including acute antiarrhythmic properties (reperfusion‐induced arrhythmias) 5–7 and chronic antiarrhythmic properties (hypertension/low potassium/β‐adrenergic‐induced ventricular fibrillation) 8–10 . A similar beneficial effect of MLT on AF was observed in patients undergoing coronary artery bypass graft surgery 11 and in a mouse model of angiotensin II‐induced AF 12 . MLT appears to be a panacea for all diseases; however, few clinical and experimental studies have challenged this paradigm 3 .…”

Effects of Melatonin on Cardiac Injury and Inflammatory Biomarkers in Patients Undergoing Coronary Artery Bypass Graft Surgery: a Meta-analysis

“…Figure 1 shows the PRISMA flowchart of the screening process in detail. Overall, five articles (six trials with 342 patients) [15][16][17][18][19] were eligible for the present meta-analysis. Among these studies, the study by Dwaich et al [18] used different doses of melatonin treatment (low versus high) for estimating the relevant outcomes, and each dose of melatonin is included as a separate trial in our meta-analysis.…”

“…In light of the antioxidative and antiinflammatory effects of melatonin [8,9], several studies utilized melatonin with the purpose of reducing oxidative stress and inflammation in CABG patients. However, their results were varied [15][16][17][18][19]. The effectiveness of melatonin supplementation was assessed following treatment using markers of inflammation and cardiac muscle injury.…”