Does Sodium Nitroprusside Decrease the Incidence of Atrial Fibrillation After Myocardial Revascularization?

Abstract

Background-Atrial fibrillation (AF) often occurs after coronary artery bypass grafting and can result in increased morbidity and mortality. In the present pilot study, our aim was to investigate whether sodium nitroprusside (SNP), as a nitric oxide donor, can reduce the frequency of post-coronary artery bypass grafting AF. Methods and Results-To investigate the effectiveness of SNP in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 100 consecutive patients in whom we performed elective and initial CABG operations. A control group of 50 patients were treated with placebo (dextrose 5% in water), whereas the SNP group (nϭ50 patients) was treated with SNP (0.5 g · kg Ϫ1 · min Ϫ1 ) during the rewarming period. High-sensitivity C-reactive protein levels were measured before surgery and 5 days postoperatively. All patients were monitored postoperatively with telemetry. Baseline characteristics were similar in both treatment groups. AF occurred in 12% of the SNP group and 27% of the control group. The occurrence of AF was significantly lower in the SNP group (Pϭ0.005). The duration of AF in the SNP group was significantly shorter than that in the control group (5.33Ϯ1.86 and 7.55Ϯ1.94 hours, respectively; Pϭ0.023). C-reactive protein levels were higher postoperatively in the control group than in the SNP group (PϽ0.05). Postoperative AF significantly prolonged postoperative hospital stay (PϽ0.05). Conclusions-The

Antioxidant Therapies in the Prevention and Treatment of Atrial Fibrillation

“…Thus, modulation of NOS activity may be an interesting therapeutic approach to prevent AF [69]. At the clinical level, a pilot randomized placebo-controlled study examined the potential role of sodium nitroprusside (SNP), as a NO donor, in the prevention of POAF [70]. Specifically, 100 consecutive patients undergoing CABG surgery were randomized to receive SNP (0.5 μg /Kg.min) or placebo (dextrose 5% in water) during the rewarming period.…”

Non-Antiarrhythmic Drugs to Prevent Atrial Fibrillation

“…Nitroprusside, which acts as a nitric oxide donor, was tested in a prospective, randomized, placebo-controlled clinical study [88] involving 100 consecutive patients after myocardial revascularization. AF occurred in 12% of the nitroprusside group and 27% of the placebo group (p = 0.005).…”

The statin therapy to prevent atrial fibrillation after cardiac surgery: Shakespearean dilemma

“…The involvement of oxidative stress in the multifactorial mechanism of POAF has been further studied by administrating antioxidant drugs to patients undergoing heart surgery. Indeed, antioxidant drugs like ascorbic acid (24), N-acetylcysteine (25), nitric oxide (26), sodium nitroprusside (27), are reported to lower the incidence of POAF after cardiac surgery involving CPB use. Another argument supporting a causative relation between oxidative stress and POAF is the higher occurrence of the arrhythmia in the elderly because they are more susceptible for ischaemia/reperfusion injury with a more important damage than in young patients and this, in part, explains the higher incidence of POAF in this population (28).…”