Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, London W2 1NY, UK.
Heart. 2011 Oct;97(20):1636-42. doi: 10.1136/heartjnl-2011-300245. Epub 2011 Aug 23.
Postoperative atrial fibrillation (POAF) affects approximately 30% of patients undergoing elective cardiac surgery. While its pathogenesis is multifactorial, increasing evidence supports a role for oxidative stress in the electrophysiological remodelling associated with AF. Although prophylactic antioxidants appear to be a potentially attractive pharmacotherapy, there is still uncertainty regarding their efficacy. This study aims to provide a quantitative summary of the current evidence surrounding antioxidant vitamins and POAF prevention.
A systematic literature review identified five randomised controlled trials incorporating 567 patients (n = 284 antioxidant, n = 283 control). These were meta-analysed using random effects modelling. Heterogeneity, subgroup analysis, quality scoring and risk of bias were assessed. Primary endpoints were the incidence of POAF and all-cause arrhythmia. Secondary endpoints were length of stay in the intensive care unit (ITU) and length of hospital stay.
Vitamins C and E significantly reduced the incidence of POAF (OR 0.43, 95% CI 0.21 to 0.89) and all-cause arrhythmia (OR 0.54, 95% CI 0.29 to 0.99) compared with controls. A significant reduction in both ITU stay (weighted mean difference (WMD) -0.44, 95% CI -0.70 to -0.17) and hospital stay (WMD -1.11, 95% CI -1.70 to -0.52) was also seen in the antioxidant group, without significant heterogeneity.
The prophylactic use of vitamins C and E may significantly reduce the incidence of POAF and all-cause arrhythmia following cardiac surgery. However, the overall quality of current studies is poor and further research should focus on adequately powered randomised controlled trials that standardise AF reporting, antioxidant protocol and the use of concomitant agents. Cost analysis should be considered to establish the potential economic benefit of antioxidant vitamin prophylaxis in POAF.
术后心房颤动（POAF）影响约 30%接受择期心脏手术的患者。虽然其发病机制是多因素的，但越来越多的证据支持氧化应激在与 AF 相关的电生理重构中起作用。尽管预防性抗氧化剂似乎是一种有吸引力的潜在药物治疗方法，但它们的疗效仍存在不确定性。本研究旨在对围绕抗氧化维生素与 POAF 预防的现有证据进行定量总结。
系统文献检索确定了五项随机对照试验，共纳入 567 例患者（n = 284 例抗氧化剂，n = 283 例对照组）。使用随机效应模型对这些试验进行荟萃分析。评估了异质性、亚组分析、质量评分和偏倚风险。主要终点是 POAF 和全因心律失常的发生率。次要终点是 ICU 住院时间和住院时间。
维生素 C 和 E 与对照组相比，显著降低 POAF（OR 0.43，95%CI 0.21 至 0.89）和全因心律失常（OR 0.54，95%CI 0.29 至 0.99）的发生率。抗氧化剂组 ICU 住院时间（加权均数差（WMD）-0.44，95%CI -0.70 至 -0.17）和住院时间（WMD -1.11，95%CI -1.70 至 -0.52）也显著降低，且无显著异质性。
心脏手术后预防性使用维生素 C 和 E 可能显著降低 POAF 和全因心律失常的发生率。然而，目前研究的总体质量较差，应进一步开展足够大样本量的随机对照试验，标准化 AF 报告、抗氧化剂方案和联合用药的使用。应考虑成本分析，以确定 POAF 中抗氧化维生素预防的潜在经济效益。
