Does Deficiency of Vitamin D Increase New Onset Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery?


  • Sadık Volkan Emren Department of Cardiology, Afyonkarahisar State Hospital, Afyonkarahisar
  • Mustafa Aldemir Department of Cardiovascular Surgery, Afyonkarahisar State Hospital, Afyonkarahisar
  • Fatih Ada Department of Cardiovascular Surgery, Afyon Kocatepe University, Afyonkarahisar



Background: Deficiency of vitamin D is known to be effective in the development of hypertension, coronary artery disease, myocardial infarction, and stroke. Deficiency of vitamin D was also shown to be associated with new onset atrial fibrillation (AF) by activating the renin-angiotensin system. This study investigated whether or not levels of vitamin D are effective in the development of AF after coronary artery bypass grafting (CABG) surgery.
Methods: A total of 283 patients undergoing CABG were included in this study. Clinical information, history of medication use, serum 25 hydroxy(OH) vitamin D, and calcium levels of all patients were evaluated preoperatively.
Results: AF developed postoperatively in 72 (25%) of patients. Serum 25(OH) vitamin D levels of patients in whom AF developed after CABG were significantly lower than patients in whom AF did not occur (15.6 ± 7.4 versus 19.1 ± 9.1; P = .004). Independent variables which were predictors of AF development in multivariate logistic regression analysis were ejection fraction (odds ratio [OR]: 0.93; 95% confidence interval [CI] 0.89-0.97; P = .003), left atrial dimensions (OR: 1.47; 95% CI 1.26-1.71; P < .001), and serum 25(OH) vitamin D levels (OR: 0.95; 95% CI 0.91-0.99; P = .035).
Conclusion: This study has shown that deficiency of vitamin D is associated with new onset AF post-CABG surgery.


Al Mheid I, Patel RS, Tangpricha V, Quyyumi AA. 2013. Vitamin D and cardiovascular disease: is the evidence solid? Eur Heart J 34:3691-8.

Almassi GH, Schowalter T, Nicolosi AC, et al. 1997. Atrial fibrillation after cardiac surgery: A major morbid event? Ann Surg 226:501-11.

Amar D, Shi W, Hogue CW, et al. 2004. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol 44:1248-53.

Aranki SF, Shaw DP, Adams DH, et al. 1996. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 94:390-7.

Banach M, Rysz J, Drozdz JA, et al. 2006. Risk factors of atrial fibrillation following coronary artery bypass grafting: a preliminary report. Circ J 70:438-41.

Brøndum-Jacobsen P, Benn M, Jensen GB, Nordestgaard BG. 2012. 25-hydroxyvitamin d levels and risk of ischemic heart disease, myocardial infarction, and early death: population-based study and metaanalyses of 18 and 17 studies. Arterioscler Thromb Vasc Biol 32:2794-2802.

Camm AJ, Lip GY, De Caterina R, et al. 2012. Focused Update of the ESC Guidelines for the Management of Atrial Fibrillation: an update of the 2010 ESC Guidelines for the Management of Atrial Fibrillation––developed with the special contribution of the European Heart Rhythm Association. Europace 14:1385-1413.

Carnes CA, Chung MK, Nakayama T, et al. 2001. Ascorbate attenuates atrial pacing-induced peroxynitrite formation and electrical remodeling and decreases the incidence of postoperative atrial fibrillation. Circ Res 89:E32-8.

Chen WR, Liu ZY, Shi Y, et al. 2014. Relation of low vitamin D to nonvalvular persistent atrial fibrillation in Chinese patients. Ann Noninvasive Electrocardiol 19:166-73.

Demir M, Uyan U, Melek M. 2014. The effects of vitamin D deficiency on atrial fibrillation. Clin Appl Thromb Hemost 20:98-103.

Filardo G, Hamilton C, Hebeler RF, et al. 2009. New-onset postoperative atrial fibrillation after isolated coronary artery bypass graft surgery and long-term survival. Circ Cardiovasc Qual Outcomes 2:164-9.

Forman JP, Giovannucci E, Holmes MD, et al. 2007. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension 49:1063-9.

Harling L, Rasoli S, Vecht JA, et al. 2011. Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials. Heart 97:1636-42.

Khatib R, Joseph P, Briel M, Yusuf S, Healey J. 2013. Blockade of the renin-angiotensin aldosteronesystem (RAAS) for primary prevention of non-valvular atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials. Int J Cardiol 165:17-24.

Kirchhof P, Fabritz L. 2014. Of hammers and screws: renin-angiotensin-aldosterone system inhibition to prevent atrial fibrillation in patients with hypertension. Eur Heart J 35:1169-71.

Lang RM, Bierig M, Devereux RB, et al. 2005. Chamber Quantification Writing Group. Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440-63.

Li YC. 2003. Vitamin D regulation of the renin-angiotensin system. J Cell Biochem 88:327-31.

Maisel WH, Rawn JD, Stevenson WG. 2001. Atrial fibrillation after cardiac surgery. Ann Intern Med 135:1061-73.

Mathew JP, Parks R, Savino JS, et al. 1996. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. Multicenter study of perioperative ischemia research group. JAMA 276:300-6.

Mathew JP, Fontes ML, Tudor IC, et al. 2004. Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 291:1720-9.

Mostafa A, EL Haddad MA, Shenoy M, Tuliani T. 2012. Atrial fibrillation post cardiac bypass surgery. Avicenna J Med 2:65-70.

Ozcan OU, Gurlek A, Gursoy E, Gerede DM, Erol C. 2015. Relation of vitamin D deficiency and new-onset atrial fibrillation among hypertensive patients. J Am Soc Hypertension 9:307-12.

Schauerte P, Scherlag BJ, Patterson E, et al. 2001. Focal atrial fibrillation: experimental evidence for a pathophysiologic role of the autonomic nervous system. J Cardiovasc Electrophysiol 12:592-9.

Vahanian A, Alfieri O, Andreotti F, et al. 2012. Joint Task Force on the Management of Valvular Heart Disease of the European Society of C, European Association for Cardio-Thoracic S, Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33:2451-96.

Villareal RP, Hariharan R, Liu BC, et al. 2004. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol 43:742-8.



How to Cite

Emren, S. V., Aldemir, M., & Ada, F. (2016). Does Deficiency of Vitamin D Increase New Onset Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery?. The Heart Surgery Forum, 19(4), E180-E184.