title: Role of irbesartan in prevention of post-coronary artery bypass graft atrial fibrillation.
abstract: 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.
  
  
  CONCLUSIONS
  Pretreatment with irbesartan tends to have a significant protective effect against the occurrence of AF during the post-operative period in patients undergoing CABG.
authors.affiliation: Dar Al-Fouad Hospital, Giza, Egypt. melhadd@med.wayne.edu
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: El-Haddad
authors.forename: Sandip K
authors.initials: SK
authors.lastname: Zalawadiya
authors.forename: Hany
authors.initials: H
authors.lastname: Awdallah
authors.forename: Sameh
authors.initials: S
authors.lastname: Sabet
authors.forename: Haitham A
authors.initials: HA
authors.lastname: El-Haddad
authors.forename: Ashraf
authors.initials: A
authors.lastname: Mostafa
authors.forename: Ahmed
authors.initials: A
authors.lastname: Rashed
authors.forename: Wael
authors.initials: W
authors.lastname: El-Naggar
authors.forename: Nabil
authors.initials: N
authors.lastname: Farag
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Saleb
authors.forename: Sony
authors.initials: S
authors.lastname: Jacob
mesh_terms: D000367:Age Factors; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D001713:Biphenyl Compounds / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000077405:Irbesartan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D016037:Single-Blind Method; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan