Evaluation of Sodium Nitroprusside Efficacy in Decreasing the Incidence and Duration of Atrial Fibrillation After Coronary Artery Bypass Grafting

Background: The incidence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG) can leave irreparable sequelae; thus, the prevention of this common arrhythmia has particular importance. The aim of this prospective study was to evaluate the efficacy of sodium nitroprusside (SNP) in lessening the incidence and duration of AF after CABG. Methods: This prospective double-blind randomized clinical trial compared the efficacy of SNP in reducing the incidence and duration of post-CABG AF between 2 groups of 30 patients each hospitalized in the Heart Surgery Department of Golestan Hospital, Ahvaz, Iran, between February 2017 and June 2017. Results: Post-CABG AF occurred in 8 (26.7%) patients in the control group and 2 (6.7%) in the SNP group (P = 0.038). The average surgery time in the control and SNP groups was 189.93 +/- 31.40 minutes and 167.47 +/- 13.48 minutes, respectively, which was statistically significant (P = 0.001). The findings concerning preoperative treatment drugs showed that 52% (26/50) of the patients without AF had used clopidogrel, with 10% (1/10) of these patients suffering AF (P = 0.015). The consumption of another agent, either angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), was accompanied by AF in 3 (30%) patients, whereas the use of another agent was not accompanied by AF in 32 (64%) patients (P = 0.046). Conclusions: This study demonstrated that the prophylactic administration of SNP during the rewarming period in CABG significantly reduced the incidence of postoperative AF and surgery time. Furthermore, preoperative treatment drugs, including clopidogrel and ACE inhibitors or ARBs played a significant role in reducing AF occurrence.