Prophylaxis postoperative atrial fibrillation (POAF) with exogenous phosphocreatine in cardiac surgery

Abstract

IntroductionAmong all cardiovascular complications, new onset postoperative atrial fibrillation (POAF) is one of the most common complications, occurring in 30% to 50% of patients after cardiac surgery. (1) One of the possible mechanisms for the development of AF may be myocardial reperfusion after aortic unclamping (reperfusion arrhythmia). In this regard, the use of agents reducing the severity of reperfusion syndrome may reduce the frequency of POAF. One such remedy is exogenous phosphocreatineThe aim of our investigation evaluation efficacy of exogenous phosphocreatine for prevention of new-onset POAF in cardiac patients.MethodsAfter Institutional Ethics Committee approval, 56 patients posted for elective GABG surgery were randomly divided into two groups (n = 28 each). In study group (Pcr) patients received 2 g of exogenous phosphocreatine iv before aortic unclamping followed by continuous infusion at a dose of 1g per hour during 3 hours after aortic unclamping; In control group (C) patients received placebo The baseline and intraoperative characteristics of the patients were similar in both groups. Continuous ECG monitoring for arrhythmias was performed at 48 hours in all patients after CABG. The diagnostic hallmarks of AF on ECG included the loss of P-waves and the presence of irregular ventricular beats. The primary point was to determine the frequency of AF within 48 hours after surgery. Secondary points were frequency of cardioversion use the frequency (paroxysms of AF lasting 5-10 minutes with adverse effects),. Chi-square/Fisher's exact/Mid P exact test and Student's t-tests were applied for categorical and continuous data.ResultsIncidence of postoperative atrial fibrillation (POAF) in group Pcr was 26% vs. 37% in group C;(p = 0.47), a difference that was not signficant. The frequency of episodes of of ventricular tachyarrhythmias requiring cardioversion in group Pcr was significantly lesser than in the control group (n-5/17,8% and n-10/35%, respectively) In the group C 11 (38%) patients developed adverse effects, mostly hypotension, compared with only 4 patient (12,3%) in group Pcr (p = 0.04). The length of ainotropic support in early postoperative period was significantly lower in group Pcr compared with control group (175±37 vs 290±89 minutes).DiscussionProphylactic perioperative infusion exogenous phosphocreatine in patients undergoing CABG surgery reduces the incidence of cardioversion, adverse effects and the length postoperative of inotropic support Among all cardiovascular complications, new onset postoperative atrial fibrillation (POAF) is one of the most common complications, occurring in 30% to 50% of patients after cardiac surgery. (1) One of the possible mechanisms for the development of AF may be myocardial reperfusion after aortic unclamping (reperfusion arrhythmia). In this regard, the use of agents reducing the severity of reperfusion syndrome may reduce the frequency of POAF. One such remedy is exogenous phosphocreatine The aim of our investigation evaluation efficacy of exogenous phosphocreatine for prevention of new-onset POAF in cardiac patients. After Institutional Ethics Committee approval, 56 patients posted for elective GABG surgery were randomly divided into two groups (n = 28 each). In study group (Pcr) patients received 2 g of exogenous phosphocreatine iv before aortic unclamping followed by continuous infusion at a dose of 1g per hour during 3 hours after aortic unclamping; In control group (C) patients received placebo The baseline and intraoperative characteristics of the patients were similar in both groups. Continuous ECG monitoring for arrhythmias was performed at 48 hours in all patients after CABG. The diagnostic hallmarks of AF on ECG included the loss of P-waves and the presence of irregular ventricular beats. The primary point was to determine the frequency of AF within 48 hours after surgery. Secondary points were frequency of cardioversion use the frequency (paroxysms of AF lasting 5-10 minutes with adverse effects),. Chi-square/Fisher's exact/Mid P exact test and Student's t-tests were applied for categorical and continuous data. Incidence of postoperative atrial fibrillation (POAF) in group Pcr was 26% vs. 37% in group C;(p = 0.47), a difference that was not signficant. The frequency of episodes of of ventricular tachyarrhythmias requiring cardioversion in group Pcr was significantly lesser than in the control group (n-5/17,8% and n-10/35%, respectively) In the group C 11 (38%) patients developed adverse effects, mostly hypotension, compared with only 4 patient (12,3%) in group Pcr (p = 0.04). The length of ainotropic support in early postoperative period was significantly lower in group Pcr compared with control group (175±37 vs 290±89 minutes). Prophylactic perioperative infusion exogenous phosphocreatine in patients undergoing CABG surgery reduces the incidence of cardioversion, adverse effects and the length postoperative of inotropic support