The Role of Vitamin D Supplementation Before Coronary Artery Bypass Grafting in Preventing Postoperative Atrial Fibrillation in Patients With Vitamin D Deficiency or Insufficiency: A Systematic Review and Meta-Analysis

Abstract

This study aims to evaluate the role of preoperative vitamin D supplementation before coronary artery bypass grafting (CABG) surgery in preventing postoperative atrial fibrillation (POAF) in vitamin D deficient or insufficient patients. Three randomized controlled trials (RCTs) comprising 448 subjects were selected after a detailed search was conducted on PubMed, Cochrane CENTRAL, Scopus, and Embase in December 2022. Analysis was run using RevMan (version 5.4.1; Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). The analysis collected risk ratio (RR) and 95% confidence interval (CI) data from the relevant studies, which were then pooled using a random effects model. A significance level of less than 0.05 (p<0.05) was considered significant. Our analysis showed that compared with the standard of care, preoperative vitamin D supplementation in vitamin D deficient and insufficient patients effectively reduced POAF after CABG surgery (RR=0.6, 95% CI=0.4-0.9, P=0.01). There was no significant difference in the duration of hospitalization between the vitamin D supplementation group compared with the control following CABG (mean difference -0.85, 95% CI -2.13 to 0.43, P = 0.19). This meta-analysis shows that preoperative vitamin D supplementation in vitamin D deficient and insufficient patients undergoing CABG can reduce the rate of POAF. As POAF is associated with many complications, providing vitamin D supplementation to individuals with a vitamin D deficiency undergoing CABG can improve long-term cardiovascular outcomes following surgery.

The Possible Influence of Vitamin D Levels on the Development of Atrial Fibrillation—An Update

“…Using the conclusions of meta-analyses devoted to this topic, the above uncertainties can be partially answered. Of the seven meta-analyses that focused on the level of VitD and its relationship to PoAF frequency, six indicated a significant effect of the VitD concentration [ 43 , 101 , 102 , 103 , 104 , 105 , 106 ]. One contrary paper also clustered papers on IAF and did not distinguish between them, so we decided to treat the aforementioned four as prognostic [ 43 ].…”

“…Despite high hopes for the potential properties of VitD in reducing the likelihood of AF episodes, there is still no clear answer to the question of the VitD utility in this regard [ 101 , 103 , 105 , 120 , 121 , 122 ]. This has to do with the limitations posed to researchers by the substance itself, whose metabolism is extensive and affects numerous tissues through interactions with nuclear and membrane cell receptors [ 123 , 124 , 125 , 126 ].…”