An Effective Method for Reducing Atrial Fibrillation

Effervescent oral vitamin C, combined with beta-blockers, can be an effective method for reducing atrial fibrillation following coronary artery bypass graft (CABG) surgery.

Most Common Arrhythmia After Surgery

Atrial fibrillation, after sinus tachycardia, is the most common arrhythmia following coronary artery bypass surgery or CABG. The incidence of atrial fibrillation after CABG varies depending on the definition used, the monitoring method for patients post-surgery, and changes in the patient characteristics of those undergoing coronary artery bypass graft surgery. In studies involving more than 300 patients, the prevalence of atrial fibrillation after CABG has varied between 17% and 33%. Patients who undergo coronary bypass surgery along with valve surgery show a higher prevalence of post-surgical atrial fibrillation compared to those undergoing just CABG surgery.

Atrial Fibrillation Post-Surgery

Atrial fibrillation after coronary artery bypass surgery is mostly self-limiting, with 80% of these patients returning to sinus rhythm within 1 to 3 days with treatment using digoxin or beta-blockers.

Risks of Atrial Fibrillation

In some cases, atrial fibrillation can increase the risk of:

Stroke
Hypertension
Pulmonary edema
Generally, patients experiencing atrial fibrillation post-surgery have a significantly higher mortality rate at 30 days and 6 months.

Complications of High Incidence of Atrial Fibrillation

Due to the high incidence of atrial fibrillation after heart surgery:

Morbidity
Mortality and related costs
Difficulty in reliably diagnosing patients at risk of post-surgical atrial fibrillation
Preventive treatment for most patients undergoing coronary bypass surgery
It is common practice for all patients without contraindications to receive beta-blockers before and after surgery. Even after preventive treatment with beta-blockers, symptomatic transient atrial fibrillation occurs in at least 25% of patients after CABG. The effect of antiarrhythmic drugs is not well defined and may carry side effects like inflammation and unwanted stress.

Treatments for Reducing Inflammation and Oxidative Stress

Treatments aimed at reducing inflammation and oxidative stress may have beneficial effects on ventricular remodeling. Effervescent vitamin C supplementation may reduce the overall occurrence of conditions such as atrial fibrillation and flutter in patients undergoing coronary artery bypass graft surgery. Since beta-blockers alone are not sufficient to prevent atrial fibrillation after CABG, effervescent vitamin C seems to be an effective and relatively safe treatment.

Atrial Fibrillation Studies

Evaluating the Effect of Simultaneous Administration of Effervescent Vitamin C and Beta-blockers

This study was designed to evaluate the effect of simultaneous administration of effervescent vitamin C with beta-blockers in reducing atrial fibrillation after CABG. Researchers administered effervescent vitamin C supplementation the night before and after surgery to patients undergoing coronary artery bypass graft surgery.

Vitamin C Treatment in Reducing Atrial Fibrillation

The treatment with effervescent vitamin C showed a significant effect in reducing atrial fibrillation after CABG. In another study, oral effervescent vitamin C reduced early recurrence after electrical cardioversion.

Preventing Atrial Fibrillation with Beta-blockers

Since most studies have shown that:

Beta-blockers are effective in preventing atrial fibrillation after CABG.

In this study, beta-blockers were administered with effervescent vitamin C simultaneously, and it was found that the combination of effervescent vitamin C and beta-blockers was more effective than beta-blockers alone in reducing atrial fibrillation after CABG. The results of single-factor and multi-factor analysis confirmed their hypothesis. The incidence of atrial fibrillation after CABG in their control group, which had only been treated with beta-blockers, was 26%. Patients undergoing heart surgery are predisposed to post-operative atrial fibrillation due to mild irregularity in the atrial refractoriness.

The period around surgery with ischemic/reperfusion injury is characterized by a delayed inflammatory response leading to a reduction in plasma antioxidants. Researchers showed that rapid atrial pacing leads to an increase in peroxynitrite levels, which are associated with atrial fibrillation. Vitamin C levels in the atrium also decrease following rapid atrial pacing.

Benefits of Vitamin C

As an antioxidant, vitamin C can prevent the oxidative stress caused by excessive atrial activity from pacing, increased sympathetic tone, and ischemic/reperfusion injury from cardiac surgery. The beneficial effects of supplementary effervescent vitamin C likely relate to reducing peroxynitrite accumulation or restoring intracellular vitamin C levels, as well as simultaneous beneficial effects on cellular repair. Calcium overload and simultaneous changes in cellular redox status may play an important role in inducing atrial arrhythmias.

Atrial Fibrillation After Surgery

In patients who develop atrial fibrillation after surgery, levels of circulating norepinephrine increase, and the influx of calcium through calcium channels is expected. Therefore, the effect of beta-blockers can reduce factors like high sympathetic tone, which occurs after previous surgery, reduce calcium overload, or help slow the sinus rate.

Simultaneous Administration of Beta-blockers and Vitamin C

The simultaneous administration of beta-blockers and effervescent vitamin C may lead to compounded beneficial effects. Reduction of sympathetic tone, calcium overload, and slowing the sinus rate (by beta-blockers) along with reduced peroxynitrite accumulation and maintaining intracellular ascorbic acid levels as an antioxidant to prevent oxidative stress may result in a reduction in atrial fibrillation after CABG. The highest incidence of atrial fibrillation is observed on days two to three after surgery, with few patients experiencing atrial fibrillation after four days post-surgery.

Less than 10% of atrial fibrillation cases occur on the first day after surgery. As expected, the average length of stay for patients with atrial fibrillation is longer than that for patients with sinus rhythm. Effervescent vitamin C is an inexpensive, low-risk, low-side effect treatment that is well tolerated by patients. Therefore, adding effervescent vitamin C before and after CABG to the standard beta-blocker regimen could result in additional beneficial effects in preventing atrial fibrillation post-CABG.

References: Eslami M, Badkoubeh RS, Mousavi M, Radmehr H, Salehi M, Tavakoli N, Avadi MR. 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. 2007;34(3):268-74. PMID: 17948074; PMCID: PMC1995047.