Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

Abstract

BackgroundPostoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass graft (CABG) surgery. This arrhythmia occurs more frequently among patients who receive perioperative inotropic therapy (PINOT). Administration of nitrates with antiplatelet agents reduces the conversion rate of cyclic guanosine monophosphate to guanosine monophosphate. This process is associated with increased concentrations of free radicals, catecholamines, and blood plasma volume. We hypothesized that patients undergoing CABG surgery who receive PINOT may be more susceptible to POAF when nitrates are administered with antiplatelet agents.MethodsClinical records were examined from a prospectively maintained cohort of 4,124 patients undergoing primary isolated CABG surgery to identify POAF-associated factors.ResultsPOAF risk was increased among patients receiving PINOT, and the greatest effect was observed when nitrates were administered with antiplatelet therapy. Adjustment for comorbidities did not substantively change the study results.ConclusionsAdministration of nitrates with certain antiplatelet agents was associated with an increased POAF risk among patients undergoing CABG surgery. Additional studies are needed to determine whether preventive strategies such as administration of antioxidants will reduce this risk.

Strain and strain rate echocardiographic imaging predict occurrence of atrial fibrillation in post-coronary artery bypass grafting patients

“…The postoperative use of inotropes did not increase the incidence of POAF in this study, contrary to Efird et al [21] findings. They deduced that patients on perioperative inotropic medications have a higher incidence of POAF especially when adding nitrates and antiplatelets.…”

“…91.8% of the no POAF group were on preoperative nitrates while only 57.1% of the POAF group were on preoperative nitrates. The preoperative nitrate administration was not studied before, while the postoperative nitrate administration with the inotropes and antiplatelets showed an increased risk for POAF as showed by Efird et al [21].…”

Post-operative atrial fibrillation in off pump coronary artery bypass graft: association with medication

“…Antiplatelet therapy was found to be an independent predictor of POAF in some studies. 1,4 Perrier et al stated that interaction between the risk factors of antiplatelet treatment and atherosclerosis could act as a confounder. 1 Efird et al, stated that in the presence of antiplatelets agents, the use of preoperative nitrates increased the POAF.…”

“…They proposed that co-administration of nitrates with antiplatelet agents reduce the conversion rate of cyclic guanosine monophosphate to guanosine monophosphate and increase concentration of free radicals and catecholamines which predispose to POAF. 4 It might also be due to the release of some proarrhythmic platelet activation compounds. 24 In this study amongst 86 patients on antiplatelet therapy 14 developed POAF.…”

“…1,3 The association of preoperative and perioperative medication like beta blocker use, preoperative antiplatelet therapy, nitrates, perioperative inotropes use have been assessed in some studies. 1,4,5 However, the literature on medication use in patients developing POAF is sparse. This study was done with an objective to determine the association of various medication use in patients undergoing CABG with postoperative atrial fibrillation.…”