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Role of Irbesartan in Prevention of Post-Coronary Artery Bypass Graft Atrial Fibrillation

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Abstract

Background and Objective

Atrial fibrillation (AF) is a common complication of cardiothoracic surgery (CTS). Existing evidence about the potential protective role of angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) for post-CTS AF has been limited and conflicting. In this single-blind, open-label, randomized prospective pilot study, we evaluated the potential protective role of irbesartan (an ARB) in post-coronary artery bypass graft (CABG) AF.

Methods

A total of 100 consecutive patients undergoing CABG were randomly assigned to irbesartan (n = 50) versus no irbesartan (n = 50) for 5 days prior to the scheduled surgery. Data were collected for imaging studies, laboratory values, and peri-operative details. Patients were monitored post-operatively for in-hospital AF episodes. Unadjusted and adjusted logistic regression analysis was performed to assess the effect of irbesartan on the incidence of post-CABG AF.

Results

A total of 14 patients developed AF during their post-operative hospital stay. The incidence of AF in patients who received irbesartan was 6% (n = 3) compared with 22% (n = 11) in patients who did not receive irbesartan (p = 0.021). Univariate logistic regression analysis identified irbesartan and age as statistically significant variables. An adjusted multivariate logistic model identified irbesartan as an important protective factor against development of post-CABG AF (adjusted odds ratio [OR] 0.20; 95% confidence interval [CI] 0.04, 0.94; p = 0.04). Increasing age (adjusted OR 1.09, 95% CI 1.01, 1.17; p = 0.03) was also identified as an independent risk factor for development of post-CABG AF.

Conclusion

Pretreatment with irbesartan tends to have a significant protective effect against the occurrence of AF during the post-operative period in patients undergoing CABG.

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Acknowledgments

No funding sources were used to conduct this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Dar Al-Fouad Hospital, Giza, Egypt and Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Mohamed A. El-Haddad, Hany Awdallah, Sameh Sabet, Nabil Farag & Mohamed A. Saleb

  2. Division of Cardiology/Electrophysiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA

    Sony Jacob

  3. Department of Internal Medicine, Wayne State University/Detroit Medical Center, 4201 St Antoine, 2E, Detroit, MI, 48201, USA

    Sandip K. Zalawadiya, Ashraf Mostafa & Sony Jacob

  4. Cairo University School of Medicine, Giza, Egypt

    Haitham A. El-Haddad, Ahmed Rashed & Wael El-Naggar

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  1. Mohamed A. El-Haddad
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  2. Sandip K. Zalawadiya
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Correspondence to Mohamed A. El-Haddad.

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El-Haddad, M.A., Zalawadiya, S.K., Awdallah, H. et al. Role of Irbesartan in Prevention of Post-Coronary Artery Bypass Graft Atrial Fibrillation. Am J Cardiovasc Drugs 11, 277–284 (2011). https://doi.org/10.2165/11587160-000000000-00000

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