Effect of Sodium Nitroprusside on the Occurrence of Atrial Fibrillation after Cardiothoracic Surgery

Abstract

Spanish

French

BACKGROUND:

Postoperative atrial fibrillation (POAF) is a frequent complication following cardiothoracic surgery and is associated with an increase in morbidity, mortality, and cost. One small prospective study of patients undergoing isolated coronary artery bypass graft surgery has demonstrated a decrease in the risk of POAF with the use of sodium nitroprusside.

OBJECTIVE:

To determine whether there is an association between intraoperative sodium nitroprusside use and the incidence of POAF.

METHODS:

A retrospective cohort of 1025 patients aged 18 years and older who underwent any cardiac surgery between April 2007 and July 2010 was evaluated at Regional Hospital of Scranton. Patients with a history of atrial fibrillation, those who had undergone cardiothoracic surgery, or those undergoing surgical treatment for atrial fibrillation were excluded. The primary outcome was the odds of developing POAF given the utilization of sodium nitroprusside during cardiothoracic surgery. POAF was defined according to the Society of Thoracic Surgeons Adult Cardiac Surgery Database version 2.61 as a new onset of atrial fibrillation/flutter requiring treatment that was not present preoperatively. Data on use of intraoperative sodium nitroprusside were obtained from the pharmacy department's billing database.

RESULTS:

The final analysis included 699 patients; 473 received sodium nitroprusside. The incidence of POAF was 25.4% in the sodium nitroprusside group and 27.9% in the control group. Univariate analysis demonstrated no association of sodium nitroprusside with POAF (OR 0.880; 95% CI 0.615 to 1.257). Multivariate analysis also showed no significant difference in the odds of POAF with sodium nitroprusside (OR 0.827; 95% CI 0.565 to 1.210). Repeating the analysis in 276 propensity score–matched patients also failed to demonstrate any association (OR 0.774; 95% CI 0.454 to 1.319).

CONCLUSIONS:

There was no significant association between the use of sodium nitroprusside during cardiothoracic surgery and POAF.

Keywords

atrial fibrillation cardiac surgical procedures cardiothoracic surgery nitric oxide

Get full access to this article

View all access options for this article.

References

Creswell

Schuessler

Rosenbloom

Cox

. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993; 56: 539–49.

Mathew

Parks

Savino

. Atrial fibrillation following coronary artery bypass graft surgery. JAMA 1996; 276: 300–6.

Aranki

Shaw

Adams

. Predictors of atrial fibrillation after coronary artery surgery: current trends and impact on hospital resources. Circulation 1996; 94: 390–7.

Almassi

Schowalter

Nicolosi

. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 1997; 226: 501–11.

Mathew

Fontes

Tudor

. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004; 291: 1720–9.

Lahey

Campos

Jennings

Pawlow

Stokes

Levitsky

. Hospital readmission after cardiac surgery. Does “fast track” cardiac surgery result in cost saving or cost shifting? Circulation 1998; 98: II35–40.

Villareal

Hariharan

Liu

. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol 2004; 43: 742–8.

Kim

Deeb

Morady

. Effect of postoperative atrial fibrillation on length of stay after cardiac surgery (The Postoperative Atrial Fibrillation in Cardiac Surgery study [PACS(2)]. Am J Cardiol 2001; 87: 881–5.

Bradley

Creswell

Hogue

Epstein

Prystowsky

Daoud

. Pharmacologic prophylaxis: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 2005; 128: 39S–47S.

10.

Dunning

Treasure

Versteegh

Nashef

. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J Cardiothorac Surg 2006; 30: 852–72.

11.

Camm

Kirchhof

Lip

. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010; 12: 1360–420.

12.

Fuster

Rydén

Cannom

. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. Circulation 2011; 123: e269–367.

13.

Davis

Packard

Hilleman

. Pharmacologic prophylaxis of postoperative atrial fibrillation in patients undergoing cardiac surgery: beyond beta-blockers. Pharmacotherapy 2010; 30: 274e–318e.

14.

Boos

Anderson

Lip

. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006; 27: 136–49.

15.

Elahi

Flatman

Matata

. Tracing the origins of postoperative atrial fibrillation: the concept of oxidative stress-mediated myocardial injury phenomenon. Eur J Cardiovasc Prev Rehabil 2008; 15: 735–41.

16.

Lin

Chen

. Nitroprusside modulates pulmonary vein arrhythmogenic activity. J Biomed Sci 2010; 17: 20.

17.

Cavolli

Kaya

Aslan

. Does sodium nitroprusside decrease the incidence of atrial fibrillation after myocardial revascularization? A pilot study. Circulation 2008; 118: 476–81.

18.

Marcus

Olgin

. Preventing atrial fibrillation after cardiac surgery: a new method using an old tool. Circulation 2008; 118: 467–8.

19.

Singh

. Letter by Singh regarding article, “Does sodium nitroprusside decrease the incidence of atrial fibrillation after myocardial revascularization? A pilot study”. Circulation 2009; 119: e486.

20.

The Society of Thoracic Surgeons. Adult cardiac surgery database training manual v2.61. 2008. www.sts.org/sections/stsnationaldatabase/datamanagers/congenitalheartsurgerydb/taskforce/articles/trainingmanual2.61.html (accessed 2011 Aug 8).

21.

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39 (suppl 1): S1–266.

22.

Schauerte

Scherlag

Patterson

. Focal atrial fibrillation: experimental evidence for a pathophysiologic role of the autonomic nervous system. J Cardiovasc Electrophysiol 2001; 12: 592–9.

23.

Ong

Chang

. Pulmonary veins and ligament of Marshall as sources of rapid activations in a canine model of sustained atrial fibrillation. Circulation 2001; 103: 1157–63.

24.

Ferrari

Alfieri

Curello

. Occurrence of oxidative stress during reperfusion of the human heart. Circulation 1990; 81: 201–11.

25.

Massoudy

Zahler

Barankay

Becker

Richter

Meisner

. Sodium nitroprusside during coronary artery bypass grafting: evidence for an antiinflammatory action. Ann Thorac Surg 1999; 67: 1059–64.

26.

Daoud

Strickberger

Man

. Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med 1997; 337: 1785–91.

27.

Mitchell

Exner

Wyse

. Prophylactic oral amiodarone for the prevention of arrhythmias that begin early after revascularization, valve replacement, or repair. JAMA 2005; 294: 3093–100.