Benefits of preoperative use of statins in minimizing the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting surgery for unstable angina

Background Several drug therapies and perioperative techniques have been proposed to prevent episodes of atrial fibrillation (AF) after cardiac surgery. Preoperative preparation and evaluation by the anesthesiologist in conjugation with the cardiologist and the surgeon is a new important role. These conjugations augment preoperative treatment and reduce much of the perioperative morbidity and mortality.Aim The aim of this work was to assess preoperative use of two regimens of statins in minimizing the incidence of postoperative AF in patients undergoing coronary artery bypass grafting operation.Patients and methods Written informed consent was obtained from all patients before the operation as regards their acceptance to be subjected to the procedure after a full explanation of its benefits and potential risks. Diagnosis of unstable angina was confirmed and patients were randomly allocated into three equal groups using the closed envelop method, according to the statin management protocol. Group I (n=15) (the control group) included patients who did not receive any statins before the operation. Group II included (n=15) patients who received atorvastatin 80 mg orally once daily starting 7 days before operation (including the morning of the operation). Group III (n=15) included patients who received atorvastatin 80 mg orally once on the day before the operation and in the morning of the day of the surgery. On the first postoperative day, all patients received atorvastatin 40 mg orally once daily and continued for 30 days postoperatively. Incidence of postoperative in-hospital AF was assessed. AF is defined as episodes of AF that lasted more than or equal to 5 min that was registered by the monitoring system and/or on a rhythm strip or 12-lead ECG and the incidence of episodes that required intervention for angina or hemodynamic compromise.Results There was no significant difference between the three groups as regards the incidence, onset, and duration of in-hospital AF (P>0.05). There were no reported cases of AF after discharge from the hospital until day 30 postoperatively (12-lead ECG was performed during every outpatient visit and on day 30 postoperatively). Moreover, there was a significantly decreased incidence of AF on increasing the duration of preoperative statin use (studied using the Mann–Whitney test).Conclusion The incidence of postoperative AF reduced in patients who received atorvastatin 80 mg for 7 days before operation. However, two doses of atorvastatin 80 mg before operation failed to reduce the incidence of postoperative AF.