Effect of prophylactic supplementation of allopurinol, magnesium and statin on the incidence of atrial fibrillation in off pump and on pump coronary artery surgery

Dr Anand Rampure Vittal Rao, Dr Santosh C Gudimani, Dr Anand . Kumar, Dr Santosh Patil, Dr Mithun V V, Dr Manjunath S Nekar

Abstract

BACKGROUND: Postoperative atrial fibrillation (POAF) is an adverse event after coronary artery bypass grafting (CABG). Various studies have reported, POAF is associated with increased early and late mortality, stroke, and prolonged hospital length of stay. Objective: To evaluate the combined effect of prophylactic supplementation of allopurinol in the immediate preoperative period, magnesium in the immediate post operative period and atorvastatin perioperatively. METHODS: This was an observational, prospective study. A total of 120 patients, underwent elective CABG surgery were allocated to off pump group or on pump group depending on whether surgery was planned off pump or on pump. Primary outcome evaluated was the incidence of AF of 5 minutes duration or longer (by rhythm analysis on ECG) requiring therapy in the first six days of postoperative period in all the patients under study and also we evaluated if there was any difference in its occurrence between off pump and on pump CABG. Statistical Analysis: Continuous variables were compared by means of students unpaired t test and categorical variables were compared by Fischers exact test. Kaplan-Meier analysis was used to compare the probability of atrial fibrillation in the Off pump and on pump groups. RESULTS: Overall 12 patients (10%) developed AF in the postoperative period. In that, 7 patients (11.6%) were from on pump group, where as 5 patients (8.3%) were from off pump group (P =0.20) and there was no statistical difference in the incidence of AF between the two groups CONCLUSION: Off pump CABG has no advantage over on pump CABG on occurrence of POAF, but perioperative supplementation of allopurinol, statin and Mg in combination may have some beneficial role in reducing the overall incidence of POAF.