Preventive Use of Ascorbic Acid For Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

  • Mohsen Mirmohammadsadeghi Department of Cardiovascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
  • Amir Mirmohammadsadeghi Department of Cardiovascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mahsa Mahmoudian slamic Azad University, Najafabad Branch, Isfahan, Iran


Background: Atrial fibrillation is one of the most frequent complications and a major risk of morbidity and mortality after cardiac surgery. Antioxidants such as vitamin C are used for prevention of this arrhythmia. Different results of studies have been reported, but most of them have shown efficiency of vitamin C in prophylaxis of postoperative AF. We tried to examine this efficacy with larger sample size.

Methods: Three hundred and fourteen on pump coronary artery bypass graft surgery alone. Patients were divided into two groups: The intervention group received vitamin C (N = 160) and the control group did not receive any
(N = 154). Intervention group was administered two grams of vitamin C intravenously (IV) 24 hours preoperatively, 500 mg
every 12 hours IV for 48 hours in ICU, and 500 mg every
12 hours PO for 48 hours in ward. Continuous monitoring in ICU and three times a day ECG was used for AF detection. The two groups were compared.

Results: The two groups were matched in terms of age, sex, LA size, ejection fraction, functional class, and TSH level. Of the patients, 244 were male. Mean age was 62 years
(40-84 years) in both groups. M/F ratio was four in both groups. Functional class and ejection fraction were the same in both groups. There was no mean TSH level difference. AF occurrence in vitamin C group was 7.6 % and in control group was 7.8 %. There was no difference in ICU or hospital stay.

Conclusions: Prophylactic use of vitamin C does not further reduce postoperative atrial fibrillation in on pump CABG patients.

Author Biographies

Mohsen Mirmohammadsadeghi, Department of Cardiovascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran

Associate Professor of Cardiovascular Surgery

Amir Mirmohammadsadeghi, Department of Cardiovascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran

Assistant Professor of Cardiovascular Surgery


Andrews TC, Reimold SC, Berlin JA, et al. 1991. Prevention of supraventricular arrhythmias after coronary artery bypass surgery: a meta-analysis of randomized controlled trials. Circulation 84:236-244.

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 94:390–397.

Caretta Q, Mercanti CA, De Nardo D, et al. 1991. Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting: multivariate analysis of preoperative, intraoperative and postoperative variables. Eur Heart J 12:1107–1111.

Carnes CA, Chung MK, Nakayama T, Nakayama H, Baliga RS, Piao S, et al. 2001. Ascorbate attenuates atrial pacing-induced peroxynitrite formation and electrical remodeling and decreases the incidence of postoperative atrial fibrillation.Circ Res. 89(6):32-8.

Chung MK. 2000. Cardiac surgery: postoperative arrhythmias. Crit Care Med. 28(10): 136–144.

Creswell LL, Schuessler RB, Rosenbloom M, et al.1993. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 36:253–261.

Eslami M, Badkoubeh RS, Mousavi M, Radmehr H, Salehi M, Tavakoli N, Avadi MR. 2007. Oral ascorbic acid in combination with beta-blockers is more effective than beta-blockers alone in the prevention of atrial fibrillation after coronary artery bypass grafting. Tex Heart Inst J. 34(3):268-74.

Hogue CW Jr, Hyder ML. 2000. Atrial fibrillation after cardiac operations: risks, mechanisms, and treatment. Ann Thorac Surg 69:300–306.

Kern LS. 2004. Postoperative atrial fibrillation: new directions in prevention and treatment. J Cardiovasc Nurs. 19(2):103-15.

Korantzopoulos P, Kolettis T, Siogas K, Goudevenos J. 2003. Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress. Med Sci Monit 9: 225–229.

Laffey JG, Boylan JF, Cheng DC. 2002. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 97(1):215-52.

Leitch JW, Thomson D, Baird DK, et al. 1990. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 100:338–342.

Mathew JP, Parks R, Savino JS, et al. 1996. Atrial fibrillation following coronary artery bypass surgery: predictors, outcomes, and resource utilization. JAMA 276:300–306.

Mayyas F, Sakurai S, Ram R, et al. 2011. Dietary ω3 fatty acids modulate the substrate for post-operative atrial fibrillation in a canine cardiac surgery model. Cardiovasc Res 89:852–61.

Ommen SR, Odell JA, Stanton MS. 1997. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med 336:1429–1434.

Papoulidisa P, Ananiadoua O, Chalvatzoulisa E, Ampatzidoub F, Koutsogiannidisa C, Karaiskosa T, et al. 2011. The role of ascorbic acid in the prevention of atrial fibrillation after elective on-pump myocardial revascularization surgery: a single-center experience – a pilot study. Interactive CardioVascular and Thoracic Surgery 12:121–124.

Rodrigo R, Korantzopoulos P, Cereceda M, Asenjo R, Zamorano J, Villalabeitia E, et al. 2013. A Randomized Controlled Trial to Prevent Post-Operative Atrial Fibrillation by Antioxidant Reinforcement. Journal of the American College of Cardiology. 62(16):1457-65.

Sisto T, Paajanen H, Metsä-Ketelä T, Harmoinen A, Nordback I, Tarkka M.1995. Pretreatment with antioxidants and allopurinol diminishes cardiac onset events in coronary artery bypass grafting. Ann Thorac Surg. 59(6):1519-23.