COMBINATION OF VITAMIN C AND B-BLOCKERS FOR PREVENTION OF ATRIAL FIBRILLATION AFTER SURGICAL MYOCARDIAL REVASCULARIZATION

Background :The use of B-blockers as a prophylactic agent against the occurrence of atrial fibrillation (AF) has proved it’s efficiency. Both inflammation and oxidative stress have been recently involved in pathogenesis of postoperative AF. The aim of our study is to evaluate the efficiency of using oral vitamin C in addition to B-blockers to prevent postoperative AF. Methods :From December 2007 to April 2008, 80 patients undergoing isolated coronary artery bypass surgery were selected and randomly divided into two groups. Group I (n = 40) received 2g of oral vitamin C one day before operation and for 5 days afterwards in addition to B-blockers. Group II (n = 40) as a control group, who received B-blockers only. Patients were monitored for the occurrence of AF from the operation time to the fifth postoperative day. Results :Preoperative patients demography and risk factors for coronary artery disease were similar among both groups. The mean number of grafts performed per patient was 3±0.6 and 2.9±0.6 in group I and II respectively (P = 0.37). Inotropic support was used more in group II 28% Vs 23%, P = 0.61. In hospital mortality was 0%. Combined morbidity (AF, wound infection, renal impairment, bleeding, reoperation ischemic changes and mediastinitis) were higher in group II 45% Vs 28%. The incidence of postoperative AF was higher in the control group than vitamin C group (25% Vs 15%) but the difference did not reach statistical significance (P = 0.088). Vitamin C group had a significantly shorter intensive care unit stay (25±3h Vs 30±12h: P = 0.017), but the mean hospital length of stay was similar among both groups. The duration of the attack of AF was short and transient among patients receiving vitamin C (50% Vs 7%). Subsequently, the number of patients receiving medical management for AF was less in Vitamin C group. Conclusions :Administration of oral vitamin C in combination with Bblockers reduces the incidence and duration of postoperative AF. Our results were not statistically significant when compared to patients receiving B-blockers alone. However, the number of patients who received further management to control AF was less in Vitamin C group.