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Evaluation of the effect of empagliflozin on prevention of atrial fibrillation after coronary artery bypass grafting: a double-blind, randomized, placebo-controlled trial

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Abstract

This study is aimed at evaluating the effect of empagliflozin in preventing atrial fibrillation after coronary artery bypass grafting (CABG). Eighty-two patients who fulfilled the inclusion criteria were allocated to the empagliflozin group (n = 43) or placebo group (n = 39). In two groups, patients received empagliflozin or placebo tablets 3 days before surgery and on the first three postoperative days (for 6 days) in addition to the standard regimen during hospitalization. During the first 3 days after surgery, types of arrhythmias after cardiac surgery, including supraventricular arrhythmias, especially postoperative atrial fibrillation (POAF), ventricular arrhythmias, and heart blocks, were assessed by electrocardiogram monitoring. C-reactive protein (CRP) levels were evaluated pre-operatively and postoperative on the third day. The incidence of POAF in the treatment group was lower compared to the control group; however, this reduction was statistically non-significant (p = 0.09). The frequency of ventricular tachycardia was reduced significantly in the treatment group versus patients in the control (p = 0.02). Also, a significant reduction in the frequency of premature ventricular contractions (PVCs) was seen in the treatment group in comparison with the control group (p = 0.001). After the intervention, CRP levels were significantly less in the empagliflozin group compared to the control group in the third postoperative day (p = 0.04). The prophylactic use of empagliflozin effectively reduced the incidence of ventricular arrhythmia in patients undergoing CABG surgery.

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Data availability

All the patients in this study were selected from the inpatients who visited the cardiac surgeon physician for CABG. Patients’ information, except for their names and personal information, can be sent upon the referee’s request.

Abbreviations

ACE:

Angiotensin-converting enzyme

AF:

Atrial fibrillation

AFL:

Atrial flutter

AVNRT:

Atrioventricular nodal reentrant tachycardia

AVRT:

Atrioventricular reentrant tachycardia

ARB:

Angiotensin receptor blocker

AR:

Aortic regurgitation

AV:

Atrioventricular

CABG:

Coronary artery bypass grafting

CBC:

Complete blood count

COPD:

Chronic obstructive pulmonary disease

CPB:

Cardiopulmonary bypass

Sr Cr:

Serum creatinine

CRP:

C-reactive protein

DBP:

Diastolic blood pressure

DM2:

Type 2 diabetes mellitus

ECG:

Electrocardiography

FBS:

Fasting blood sugar

HbA1c:

Glycated hemoglobin

HF:

Heart failure

HTN:

Hypertension

ICU:

Intensive care unit

IHD:

Ischemic heart disease

iNOS:

Inducible nitric oxide synthase

IL-6:

Interleukin-6

LBBB:

Left bundle branch block

LVEF:

Left ventricular ejection fraction

MR:

Mitral regurgitation

POAF:

Postoperative atrial fibrillation

PLT:

Platelet

PR:

Pulmonary regurgitation

PVC:

Premature ventricular contraction

RR:

Respiratory rate

RBBB:

Right bundle branch block

RVDD:

Right ventricular diastolic dysfunction

TC:

Total cholesterol

TG:

Triglyceride

TNF-alpha:

Tumor necrosis factor-alpha

TR:

Tricuspid regurgitation

SBP:

Systolic blood pressure

SGLT2:

Sodium-glucose transporter 2

SGOT:

Serum glutamic-oxaloacetic transaminase

SGPT:

Serum glutamic-pyruvic transaminase

VT:

Ventricular tachycardia

VF:

Ventricular fibrillation

WBC:

White blood cell

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Acknowledgements

We would like to express our gratitude to the following individuals and organizations for their contributions and support throughout this research: Sara Afshar, Hoorak Poorzand, and Sharareh Ferdows, Department of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran, for their cooperation in performing echocardiography and introduction of patients and monitoring the correct and ordinary use of drugs prescribed for patients, hel** us do the survey accurately.

Funding

This work was supported by Research Council of Mashhad University of Medical Sciences.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

    Batool Zarei & Amir Hooshang Mohammadpour

  2. Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran

    Benyamin Fazli

  3. Interventional Cardiac Electrophysiologist, Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Mohammad Tayyebi

  4. Department of Cardiac Surgery, Mashhad University of Medical Sciences, Mashhad, Iran

    Mohammad Abbasi Teshnizi, Aliasghar Moeinipour & Omid Javedanfar

  5. Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Reza Javidi Dasht Bayaz & Malihe Rahmati

  6. Department of Biostatistics, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Vahid Ghavami

  7. Department of Anesthesia, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Shahram Amini

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  1. Batool Zarei
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Contributions

Amir Hooshang Mohammadpour, Shahram Amini, and Mohammad Tayyebi contributed to the study’s conception and design. Batool Zarei, Reza Javidi Dasht Bayaz, and Malihe Rahmati did the research and collected the data. Vahid Ghavami performed the statistical analysis of the data. Batool Zarei wrote the first draft of the manuscript. Amir Hooshang Mohammadpour and Shahram Amini critically revised the manuscript. Benyamin Fazli is a critical care medicine specialist who evaluated the hemodynamic parameters and global assessment of the patients undergoing the CABG surgery. Mohammad Abbasi Teshnizi, Aliasghar Moeinipour, and Omid Javedanfar are cardiac surgeons who performed CABG surgery. All authors read and approved the final manuscript. The authors declare that all data were generated in-house and that no paper mill was used.

Corresponding authors

Correspondence to Shahram Amini or Amir Hooshang Mohammadpour.

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Ethical approval

The local Ethics Committee of Mashhad University of Medical Sciences (MUMS) approved the study protocol (reference number: IR.MUMS.REC.1401.129), and the study was registered on the Iranian registry of clinical trials as IRCT20120520009801N9. Protocol of the study was explained to all participants, and signed written consent forms were obtained.

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Zarei, B., Fazli, B., Tayyebi, M. et al. Evaluation of the effect of empagliflozin on prevention of atrial fibrillation after coronary artery bypass grafting: a double-blind, randomized, placebo-controlled trial. Naunyn-Schmiedeberg's Arch Pharmacol (2024). https://doi.org/10.1007/s00210-024-03225-1

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