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A randomized controlled trial to prevent post-operative atrial fibrillation by antioxidant reinforcement.
J Am Coll Cardiol. 2013 Oct 15; 62(16):1457-65.JACC

Abstract

OBJECTIVES

This study was designed to assess whether the reinforcement of the antioxidant system, through n-3 fatty acids plus antioxidant vitamin supplementation, could reduce the incidence of post-operative atrial fibrillation.

BACKGROUND

Therapy to prevent post-operative atrial fibrillation remains suboptimal. Although oxidative stress plays a key role in the pathogenesis of this arrhythmia, antioxidant reinforcement has produced controversial results.

METHODS

A total of 203 patients scheduled for on-pump cardiac surgery were randomized to placebo or supplementation with n-3 polyunsaturated fatty acids (2 g/day) (eicosapentaenoic acid:docosahexaenoic acid ratio 1:2), vitamin C (1 g/day), and vitamin E (400 IU/day). The primary outcome was the occurrence of post-operative atrial fibrillation. Secondary outcomes were the biomarkers related to oxidative stress and inflammation.

RESULTS

Post-operative atrial fibrillation occurred in 10 of 103 patients (9.7%) in the supplemented group versus 32 of 100 patients (32%) in the placebo group (p < 0.001). Early after surgery, placebo patients presented with increased levels of biomarkers of inflammation and oxidative stress, which were markedly attenuated by antioxidant supplementation. The activity of catalase, superoxide dismutase, and glutathione peroxidase in atrial tissue of the supplemented patients was 24.0%, 17.1%, and 19.7% higher than the respective placebo values (p < 0.05). The atrial tissue of patients who developed atrial fibrillation showed NADPH oxidase p47-phox subunit protein and mRNA expression 38.4% and 35.7% higher, respectively, than patients in sinus rhythm (p < 0.05).

CONCLUSIONS

This safe, well-tolerated, and low-cost regimen, consisting of n-3 polyunsaturated fatty acids plus vitamins C and E supplementation, favorably affected post-operative atrial fibrillation, increased antioxidant potential, and attenuated oxidative stress and inflammation. (Prevention of Post-Operative Atrial Fibrillation: Pathophysiological Characterization of a Pharmacological Intervention Based on a Novel Model of Nonhypoxic Pre-Conditioning; ISRCTN45347268).

Authors+Show Affiliations

Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile. Electronic address: rrodrigo@med.uchile.cl.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23916928

Citation

Rodrigo, Ramón, et al. "A Randomized Controlled Trial to Prevent Post-operative Atrial Fibrillation By Antioxidant Reinforcement." Journal of the American College of Cardiology, vol. 62, no. 16, 2013, pp. 1457-65.
Rodrigo R, Korantzopoulos P, Cereceda M, et al. A randomized controlled trial to prevent post-operative atrial fibrillation by antioxidant reinforcement. J Am Coll Cardiol. 2013;62(16):1457-65.
Rodrigo, R., Korantzopoulos, P., Cereceda, M., Asenjo, R., Zamorano, J., Villalabeitia, E., Baeza, C., Aguayo, R., Castillo, R., Carrasco, R., & Gormaz, J. G. (2013). A randomized controlled trial to prevent post-operative atrial fibrillation by antioxidant reinforcement. Journal of the American College of Cardiology, 62(16), 1457-65. https://doi.org/10.1016/j.jacc.2013.07.014
Rodrigo R, et al. A Randomized Controlled Trial to Prevent Post-operative Atrial Fibrillation By Antioxidant Reinforcement. J Am Coll Cardiol. 2013 Oct 15;62(16):1457-65. PubMed PMID: 23916928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized controlled trial to prevent post-operative atrial fibrillation by antioxidant reinforcement. AU - Rodrigo,Ramón, AU - Korantzopoulos,Panagiotis, AU - Cereceda,Mauricio, AU - Asenjo,René, AU - Zamorano,Jaime, AU - Villalabeitia,Eli, AU - Baeza,Cristián, AU - Aguayo,Rubén, AU - Castillo,Rodrigo, AU - Carrasco,Rodrigo, AU - Gormaz,Juan G, Y1 - 2013/07/31/ PY - 2013/04/22/received PY - 2013/06/18/revised PY - 2013/07/08/accepted PY - 2013/8/7/entrez PY - 2013/8/7/pubmed PY - 2013/12/16/medline KW - DHA KW - EPA KW - MDA KW - POAF KW - PUFA KW - ROS KW - antioxidants KW - docosahexaenoic acid KW - eicosapentaenoic acid KW - inflammation KW - malondialdehyde KW - n-3 fatty acids KW - oxidative stress KW - polyunsaturated fatty acid KW - post-operative atrial fibrillation KW - reactive oxygen species KW - vitamin C KW - vitamin E SP - 1457 EP - 65 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 62 IS - 16 N2 - OBJECTIVES: This study was designed to assess whether the reinforcement of the antioxidant system, through n-3 fatty acids plus antioxidant vitamin supplementation, could reduce the incidence of post-operative atrial fibrillation. BACKGROUND: Therapy to prevent post-operative atrial fibrillation remains suboptimal. Although oxidative stress plays a key role in the pathogenesis of this arrhythmia, antioxidant reinforcement has produced controversial results. METHODS: A total of 203 patients scheduled for on-pump cardiac surgery were randomized to placebo or supplementation with n-3 polyunsaturated fatty acids (2 g/day) (eicosapentaenoic acid:docosahexaenoic acid ratio 1:2), vitamin C (1 g/day), and vitamin E (400 IU/day). The primary outcome was the occurrence of post-operative atrial fibrillation. Secondary outcomes were the biomarkers related to oxidative stress and inflammation. RESULTS: Post-operative atrial fibrillation occurred in 10 of 103 patients (9.7%) in the supplemented group versus 32 of 100 patients (32%) in the placebo group (p < 0.001). Early after surgery, placebo patients presented with increased levels of biomarkers of inflammation and oxidative stress, which were markedly attenuated by antioxidant supplementation. The activity of catalase, superoxide dismutase, and glutathione peroxidase in atrial tissue of the supplemented patients was 24.0%, 17.1%, and 19.7% higher than the respective placebo values (p < 0.05). The atrial tissue of patients who developed atrial fibrillation showed NADPH oxidase p47-phox subunit protein and mRNA expression 38.4% and 35.7% higher, respectively, than patients in sinus rhythm (p < 0.05). CONCLUSIONS: This safe, well-tolerated, and low-cost regimen, consisting of n-3 polyunsaturated fatty acids plus vitamins C and E supplementation, favorably affected post-operative atrial fibrillation, increased antioxidant potential, and attenuated oxidative stress and inflammation. (Prevention of Post-Operative Atrial Fibrillation: Pathophysiological Characterization of a Pharmacological Intervention Based on a Novel Model of Nonhypoxic Pre-Conditioning; ISRCTN45347268). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/23916928/A_randomized_controlled_trial_to_prevent_post_operative_atrial_fibrillation_by_antioxidant_reinforcement_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(13)02780-0 DB - PRIME DP - Unbound Medicine ER -