Cor Vasa 2002, 43(10):396-400

The role of nonsteroidal antiinflammatory drugs in the prevention of postoperative atrial fibrillation after open-heart surgery

Marek Šetina^1,*, Hana Pospíšilová¹, Aleš Mokráček¹, Kateřina Popelková², Daniel Čoček¹, Milan Vambera², František Toušek²

¹ Kardiochirurgické oddělení

² Kardiologické oddělení, Nemocnice České Budějovice, Česká republika

Introduction:
Atrial fibrillation (AF) after cardiac surgery procedures occurs in 10 to 50%. Possible causative factors include electrolyte imbalance, excess catecholamines, atrial ischemia, pericardial irritation, and inflammatory response. Numerous investigations have examined methods of preventing postoperative AF. The most often tested agents were amiodarone, beta-blockers and magnesium. In our study, we investigated the role of nonsteroidal anti-inflammatory drugs (NSAID) in the prevention of postoperative AF. The rationale for the study was that NSAID could suppress both the body's inflammatory response and pericardial irritation.

Methods:
Our prospective randomized study included 110 consecutive patients. NSAID were used for the treatment of postoperative pain in 57 patients (NSAID group). Another group comprised 53 patients (non-NSAID group) receiving analgesics without an anti-inflammatory effect (metamizole). The primary end point was the incidence of AF in both groups. Secondary end points were mortality, occurrence of postoperative complications, and length of hospital stay (LOS). We selected a group of patients undergoing on-pump CABG (coronary artery bypass graft) with cardioplegic heart arrest. In this relatively homogeneous group, we evaluated the relationship between AF and LOS regardless of the group (NSAID or non-NSAID) each patient had been assigned to.

Results:
The incidence of postoperative AF was 31.6% in the NSAID group and 47% in the non-NSAID group (p < 0.01). Mortality was zero in both groups. The LOS was 8.35 ± 3.05 days in the NSAID group, and 8.37 ± 2.46 days in the non- NSAID group (p = NS). The incidence of postoperative complications did not differ significantly between the two groups. The LOS in patients with on-pump CABG with cardioplegic heart arrest without AF was 7.35 ± 2.5 days compared to 9.73 ± 2.6 days in patients with AF (p < 0.05).

Conclusion:
Postoperative administration of NSAID significantly reduced the incidence of AF. Because of their combined anti-inflammatory and analgesic effect, NSAID are advantageous both for the management of postoperative pain and for the prevention of postoperative AF.

Keywords: Atrial fibrillation; Nonsteroidal anti-inflammatory drugs; Cardiac surgery

Published: October 1, 2002  Show citation