The role of ascorbic acid in the prevention of atrial fibrillation after elective on-pump myocardial revascularization surgery: a single-center experience--a pilot study. Ascorbate Attenuates Atrial Pacing-Induced Peroxynitrite Formation and Electrical Remodeling and Decreases the Incidence of Postoperative Atrial Fibrillation Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies. Cardiac rate normalization in chronic atrial fibrillation: comparison of long-term efficacy of treatment with amiodarone versus AV node ablation and permanent His-bundle pacing. Vernakalant Hydrochloride for the Rapid Conversion of Atrial Fibrillation After Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial). Rationale and Design of FIRE AND ICE: A multicenter randomized trial comparing efficacy and safety of pulmonary vein isolation using a cryoballoon versus radiofrequency ablation with 3D-reconstruction. Fish intake and risk of incident atrial fibrillation. Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: The TOPCAT Trial. Oral vitamin C administration reduces early recurrence rates after electrical cardioversion of persistent atrial fibrillation and attenuates associated inflammation. Palpitations are predictive of future atrial fibrillation. An 11-year follow-up of 22,815 men and women: the Tromsø Study Magnesium infusion and postoperative atrial fibrillation: a randomized clinical trial. C-reactive protein and atrial fibrillation: "evidence for the presence of inflammation in the perpetuation of the arrhythmia". The −174G/C Interleukin-6 Polymorphism Influences Postoperative Interleukin-6 Levels and Postoperative Atrial Fibrillation. Is Atrial Fibrillation an Inflammatory Complication? Comparison of rate and rhythm control in hypertension patients with atrial fibrillation. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study) Heat shock protein70: a new marker for subsequent atrial fibrillation development?
Atrial fibrillation ( AF ) is a common arrhythmia that occurs postoperatively in cardiac surgery . There is evidence for the role of oxidative stress in the etiology of AF . In our study , we examined whether antioxidant ascorbic acid ( vitamin C ) , could help in the reduction of the incidence of postoperative AF . Patients who were scheduled to undergo elective isolated on-pump coronary artery bypass grafting ( CABG ) were included in our study . One hundred and seventy patients were r and omly divided in two groups : Group A ( n=85 ) received vitamin C preoperatively and postoperatively whereas Group B ( n=85 ) did not receive any ( control group ) . The incidence of AF was 44.7 % in the vitamin C group and 61.2 % in the control group ( P=0.041 ) . The hospitalization time , the intensive care unit stay and the time interval for the conversion of AF into sinus rhythm was significantly shorter in the vitamin C group . Patients that developed AF also had longer hospital length of stay ( 9.5±2.8 days vs. 6.7±1.9 , P=0.034 ) . Supplementation of vitamin C reduces the incidence of postCABG AF , and decreases the time needed for rhythm restoration and length of hospital stay Atrial fibrillation ( AF ) , the most common chronic arrhythmia , increases the risk of stroke and is an independent predictor of mortality . Available pharmacological treatments have limited efficacy . Once initiated , AF tends to self-perpetuate , owing in part to electrophysiological remodeling in the atria ; however , the fundamental mechanisms underlying this process are still unclear . We have recently demonstrated that chronic human AF is associated with increased atrial oxidative stress and peroxynitrite formation ; we have now tested the hypothesis that these events participate in both pacing-induced atrial electrophysiological remodeling and in the occurrence of AF following  cardiac surgery . In chronically instrumented dogs , we found that rapid ( 400 min−1 ) atrial pacing was associated with attenuation of the atrial effective refractory period ( ERP ) . Treatment with ascorbate , an antioxidant and peroxynitrite decomposition catalyst , did not directly modify the ERP , but attenuated the pacing-induced atrial ERP shortening following 24 to 48 hours of pacing . Biochemical studies revealed that pacing was associated with decreased tissue ascorbate levels and increased protein nitration ( a biomarker of peroxynitrite formation ) . Oral ascorbate supplementation attenuated both of these changes . To evaluate the clinical significance of these observations , supplemental ascorbate was given to 43 patients before , and for 5 days following , cardiac bypass graft surgery . Patients receiving ascorbate had a 16.3 % incidence of postoperative AF , compared with 34.9 % in control subjects . In combination , these studies suggest that oxidative stress underlies early atrial electrophysiological remodeling and offer novel insight into the etiology and potential treatment of an enigmatic and difficult to control arrhythmia . The full text of this article is available at http://www.circresaha.org Atrial fibrillation ( AF ) represents the most common sustained cardiac arrhythmia in patients with heart failure ( HF ) . AF in HF patients is associated with worsening of symptoms and also results in a substantial increase in mortality . Although HF patients in sinus rhythm have a better outcome than patients with AF , several r and omized studies investigating pharmacological rhythm control versus rate control have shown no advantage of one strategy over the other in terms of patient outcomes . Catheter-based ablation therapy is a newer therapeutic option with a rapidly evolving and changing role in the management of this arrhythmia . In the present review , the authors discuss the epidemiology , pathophysiology and prognostic significance of AF in patients with HF . Exclusively addressed are studies investigating catheter-based ablation for rhythm-control and rate-control therapies in the management of AF in HF patients Chronic atrial fibrillation ( AF ) is a common arrhythmia with significant morbidity and mortality . AF has been the subject of considerable attention and intensive clinical research in recent years . Current opinion on the management of AF favors the restoration and maintenance of normal ventricular rhythm . This has several potential benefits , including the alleviation of arrhythmia-associated symptoms and hemodynamic improvements . Maintenance of frequents normalization of ventricular rhythm ( NVR ) can be achieved with antiarrhythmic drug therapy or with AV node radiofrequency ablation ( RFA ) and permanent ventricular pacing . Recent interest has focused on the use of class III antiarrhythmic agents , such as amiodarone hydrochloride . This investigation compared amiodarone to AV node RFA and permanent pacing of the His-bundle area in maintaining NVR in patients with resistant chronic AF . After 12 months of treatment with amiodarone ( 200 to 400 mg/d ) 30 % of patients remained in NVR , 30 % were in transitional phase of improvement , and 40 % showed negative effect . Only a few patients in this group developed ocular or hepatic side effects . On one year follow-up was achieved in 100 % of cases without any clinical ly significant side effects being seen . In conclusion , analysis of the results of this study suggests that low-dose amiodarone is well tolerated in the management of chronic AF in a selected patient population . The more aggressive interventional radiofrequency ablation technique is significantly more effective and more reliable in the long-term clinical treatment of drug-resistant AF Background —Postoperative atrial arrhythmias are common and are associated with considerable morbidity . This study was design ed to evaluate the efficacy and safety of vernakalant for the conversion of  atrial fibrillation ( AF ) or  atrial flutter ( AFL ) after cardiac surgery . Methods and Results —This was a prospect i ve , r and omized , double-blind , placebo-controlled trial of vernakalant for the conversion of AF or AFL  after coronary artery bypass graft , valvular surgery , or both . Patients were r and omly assigned 2:1 to receive a 10-minute infusion of 3 mg/kg vernakalant or placebo . If AF or AFL was present after a 15-minute observation period , then a second 10-minute infusion of 2 mg/kg vernakalant or placebo was given . The primary end point was the conversion of postcardiac surgery AF or AFL to sinus rhythm within 90 minutes of dosing . In patients with AF , 47 of 100 ( 47 % ) who received vernakalant converted to SR compared with 7 of 50 ( 14 % ) patients who received placebo ( P<0.001 ) . The median time to conversion was 12 minutes . Vernakalant was not effective in converting postoperative AFL to sinus rhythm . Two serious adverse events occurred within 24 hours of vernakalant administration ( hypotension and complete atrioventricular block ) . There were no cases of torsades de pointes , sustained ventricular tachycardia , or ventricular fibrillation . There were no deaths . Conclusions —Vernakalant was safe and effective in the rapid conversion of AF to sinus rhythm in patients who had AF after cardiac surgery . Clinical Trial Registration — clinical trials.gov . Identifier : NCT00125320 BACKGROUND Inflammation and oxidative stress are associated with atrial fibrillation ( AF ) .  Statins have antioxidant and anti-inflammatory properties . We tested if atorvastatin reduced AF recurrence after DC cardioversion ( CV ) by modifying systemic oxidative stress and inflammation ( NCT00252967 ) . METHODS AND RESULTS In a r and omized , double-blinded , placebo-controlled trial , patients with atrial fibrillation/flutter ( AF ) were r and omized to receive either  atorvastatin 80 mg ( n = 33 )  or placebo ( n = 31 ) before CV . Treatment was continued for 12 months or until AF recurred . Serum oxidative stress markers ( ratios of oxidized to reduced glutathione and cysteine , derivatives of reactive oxygen species , isoprostanes ) and inflammatory markers ( high-sensitivity C- reactive protein [ hs-CRP ] , interleukin-6 [ IL-6 ] , interleukin-1β[IL-1β ] , tumor necrosis factor alpha [ TNFα ] ) were measured at baseline and on follow-up . AF recurred in 22 ( 66.7 % ) of atorvastatin and 26 ( 83.9 % ) of placebo group ( P = 0.2 ) . The adjusted hazard ratio of having recurrence on atorvastatin versus on placebo was 0.99 ( 95 % CI : 0.98 - 1.01 , P = 0.3 ) . There was no significant difference in the time to recurrence using Kaplan-Meier survival estimates ( median [ IR ] : 29 [ 2 - 145 ] days versus 22 [ 7 - 70 ] days , P = 0.9 ) . Although no significant effect was seen on oxidative stress , 2 of 4 inflammatory markers , IL-6 ( adjusted OR : 0.59 , 95 % CI : 0.35 - 0.97 , P = 0.04 ) and hs-CRP ( adjusted OR : 0.59 , 95 % CI : 0.37 - 0.95 , P = 0.03 ) were significantly lowered with atorvastatin  . Cholesterol levels significantly decreased with atorvastatin ( P = 0.03 ) . CONCLUSIONS High-dose atorvastatin did not reduce the recurrence of AF after CV . It reduced selective markers of inflammation without affecting systemic oxidative stress . Failure of atorvastatin to prevent AF recurrence may be due to its failure to affect oxidative stress BACKGROUND Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia imposing substantial morbidity and mortality . Catheter-based pulmonary vein isolation ( PVI ) using radiofrequency current ( RFC ) has become a st and ard treatment for drug-resistant and symptomatic paroxysmal AF ( PAF ) . In recent years , the cryoballoon-based technique is increasingly used as a promising alternative with a short learning curve . METHODS The FIRE AND ICE trial is a prospect i ve , r and omized , controlled , open , blinded outcome assessment , noninferiority trial comparing cryoballoon- , and RFC-based PVI .  Patients with drug-resistant PAF will be r and omized in a 1:1 matrix in multiple European centers . The primary hypothesis is that cryoballoon ablation is not inferior to RFC ablation using 3-dimensional mapping with respect to clinical efficacy . The primary endpoint is defined as the time to first documented clinical failure , including : ( 1 ) recurrence of AF ; ( 2 ) atrial flutter or atrial tachycardia ; ( 3 ) prescription of class I or III antiarrhythmic drugs ; or ( 4 ) re-ablation , whichever comes first , following a blanking period of 3 months after the index ablation procedure . The primary safety endpoint is a composite of death , stroke/transient ischemic attack , cardiac arrhythmias ( apart from AF recurrence ) causally related to the therapeutic intervention , and procedure-related serious adverse events . CONCLUSION The FIRE AND ICE trial compares 2 different technologies to perform catheter ablation of PAF with respect to efficacy and safety . It aims at providing objective data to guide selection and usage of ablation catheters in the treatment of AF BACKGROUND Atrial fibrillation ( AF ) is the most common arrhythmia in clinical practice and is particularly common in the elderly . Although effects of fish intake , including potential antiarrhythmic effects , may favorably influence risk of AF , relationships between fish intake and AF incidence have not been evaluated . METHODS AND RESULTS In a prospect i ve , population -based cohort of 4815 adults > or = age 65 years , usual dietary intake  was assessed at baseline in 1989 and 1990 . Consumption of tuna and other broiled or baked fish correlated with plasma phospholipid long-chain n-3 fatty acids , whereas consumption of fried fish or fish s and wiches ( fish burgers ) did not . AF incidence was prospect ively ascertained on the basis of hospital discharge records and annual electrocardiograms . During 12 years ' follow-up , 980 cases of incident AF were diagnosed . In multivariate analyses , consumption of tuna or other broiled or baked fish was inversely associated with incidence of AF , with 28 % lower risk with intake 1 to 4 times per week ( HR=0.72 , 95 % CI=0.58 to 0.91 , P=0.005 ) , and 31 % lower risk with intake > or = 5 times per week ( HR=0.69 , 95 % CI=0.52 to 0.91 , P=0.008 ) , compared with < 1 time per month ( P trend=0.004 ) . Results were not material ly different after adjustment for preceding myocardial infa rct ion or congestive heart failure . In similar analyses , fried fish/fish s and wich consumption was not associated with lower risk of AF . CONCLUSIONS Among elderly adults , consumption of tuna or other broiled or baked fish , but not fried fish or fish s and wiches , is associated with lower incidence of AF . Fish intake may influence risk of this common cardiac arrhythmia OBJECTIVES This study assessed the relationship between atrial fibrillation ( AF ) and outcomes in the TOPCAT ( Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist ) trial , to evaluate whether AF modified the treatment response to spironolactone and whether spironolactone influenced post-r and omization AF . BACKGROUND AF is common in heart failure with preserved ejection fraction ( HFpEF ) and likely contributes to increased risk of adverse outcomes . METHODS A total 1,765 patients enrolled in TOPCAT trial in North and South America were divided into 3 groups : no known AF , history of AF without AF at enrollment  , and AF found on the electrocardiogram ( ECG ) at enrollment . We assessed outcomes and treatment response to spironolactone in all groups , and the association between post-r and omization AF and outcomes in patients free of AF at baseline . The primary outcome of the TOPCAT trial was a composite of cardiovascular mortality , aborted cardiac arrest , or heart failure hospitalization . RESULTS A total of 760 patients ( 43 % ) had a history of AF ( 18 % ) or AF on ECG at enrollment ( 25 % ) . The highest adjusted risk was associated with AF at enrollment ( primary outcome , hazard ratio : 1.34 ; 95 % confidence interval : 1.09 to 1.65 ; p = 0.006 ; and an increased early risk of secondary outcomes ) . Neither history of AF nor AF at enrollment modified the beneficial treatment effect of spironolactone . Post-r and omization AF , which occurred in 6.3 % of patients , was not influenced by spironolactone treatment , but was associated with an increased early risk of the primary outcome ( hazard ratio : 2.32 ; 95 % confidence interval : 1.59 to 3.40 ; p < 0.0001 ) and secondary outcomes . CONCLUSIONS AF at enrollment was associated with increased cardiovascular risk in HFpEF patients in the TOPCAT study . Post-r and omization AF , which was associated with an increased risk of morbidity and mortality , was not influenced by spironolactone . ( Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [ TOPCAT ] ; NCT00094302 ) BACKGROUND Inflammation and oxidative stress have been recently implicated in the pathophysiology of atrial fibrillation ( AF ) . The aim of this study was to examine the potential benefit of vitamin C on the early recurrence rates and on inflammatory indices after successful cardioversion of persistent AF , as well as to investigate the time course of changes in these indices post-cardioversion . METHODS We prospect ively studied 44 consecutive patients after successful electrical cardioversion of persistent AF .  All patients received st and ard treatment and were r and omised in one to one fashion to either oral vitamin C administration or no additional therapy . We followed-up the patients for 7 days performing successive measurements of white blood cell ( WBC ) count , C-reactive protein ( CRP ) , fibrinogen , and ferritin levels . RESULTS One week after successful cardioversion , AF recurred in 4.5 % of patients in the vitamin C group and in 36.3 % of patients in the control group ( p=0.024 ) . Compared to baseline values , inflammatory indices decreased after cardioversion in patients receiving vitamin C but did not change significantly in the control group . A significant variance was found in the serial measurements of WBC counts ( F=5.86 , p=0.001 ) and of fibrinogen levels ( F=4.10 , p=0.0084 ) in the two groups . In the vitamin C group CRP levels were lower on the seventh day ( p<0.05 ) . CRP and fibrinogen levels were higher in patients who relapsed into AF compared to patients who maintained sinus rhythm ( F=2.77 , p=0.044 and F=3.51 , p=0.017 , respectively ) . CONCLUSIONS These findings suggest that vitamin C reduces the early recurrence rates after cardioversion of persistent AF and attenuates the associated low-level inflammation . These effects indicate that therapeutic approaches targeting at inflammation and oxidative stress may exert favourable effects on atrial electrical remodeling Background : Atrial fibrillation ( AF ) is a common cardiac arrhythmia which increases morbidity and mortality . Identification of risk factors is therefore important . We examined the impact of palpitations and cardiovascular risk factors in prediction of AF ( all types ) and lone AF in a large population -based cohort . Design : We carried out a prospect i ve population -based cohort study . Methods : A total of 22,815 participants from a population survey in 1994–1995 were followed-up for a mean of 11.1 years . Mean age at baseline was 46 years . Measurements of height , weight , blood pressure , heart rate , total cholesterol and high-density lipoprotein (HDL)-cholesterol , and information on palpitations , diabetes , angina , myocardial infa rct ion , and antihypertensive treatment were obtained at baseline . The outcome measure was first-ever AF , documented on an electrocardiogram .  Cox proportional hazards regression model was used to estimate hazard ratios ( HRs ) for AF . Results : Palpitations were associated with increased risk of AF in both women ( HR 1.62 , 95 % confidence interval [ CI ] 1.29–2.02 ) and men ( HR 1.91 , 95 % CI 1.54–2.35 ) . For hypertension the HR for AF was 1.98 ( 1.46 - 2.69 ) in women and 1.40 ( 1.13 - 1.74 ) in men . The HR for 1 SD increase in body mass index ( BMI ) was 1.16 ( 1.06–1.27 ) in women and 1.47 ( 1.32–1.63 ) in men . Body height and BMI were associated with increased risk for lone AF in men . Conclusion : Palpitations , hypertension and BMI were predictive of future atrial fibrillation in both sexes BACKGROUND Postoperative arrhythmias are among the most common complications of cardiac surgery . Total serum magnesium concentration will change after coronary bypass surgery but compensatory prophylactic administration of magnesium has remained a controversial issue . We studied whether prophylactic administration of magnesium could prevent post-coronary artery bypass grafting ( CABG ) arrhythmias and evaluated the effects of diabetes mellitus on prophylactic magnesium administration . METHODS In a clinical trial , 345 consecutive CABG c and i date s were r and omly assigned to study ( n = 166 , 48.1 % ) and control groups . Patients in study group received supplemental magnesium infusion as following : 2 g [ corrected ] after induction of anesthesia until cardio-pulmonary bypass and then 8 g upon arrival in Intensive Care Unit ( ICU ) until 24 hr . Total serum magnesium concentration was measured at four design ated time points : onset of induction , and 0 , 24 and 48 hr after ICU admission . Cardiac arrhythmias were sought with a 12-lead electrocardiogram ( ECG ) from the end of surgery up till discharge . RESULTS Atrial Fibrillation ( Af ) occurred in 34 patients ( 9.9 % ) . Total serum magnesium concentration was significantly higher in patients who received supplemental magnesium ( P < 0.001 ) and significantly lower in Af patients ( P= 0.02 ) . Among non-diabetics , Af incidence was significantly lower in study group compared with control group . CONCLUSIONS The occurrence of atrial fibrillation correlates with serum magnesium level . Diabetes mellitus probably hampers prophylactic effect of supplemental magnesium in preventing the occurrence of Af BACKGROUND Atrial fibrillation ( AF ) is associated to a high risk of systemic embolism . The mechanisms that contribute to thrombogenesis in these patients are still poorly understood . Systemic and /or local inflammation could be involved in the process of thrombogenesis and contribute to the perpetuation of the arrhythmia . The purpose of the study was to evaluate the role of inflammation and its relation to thrombogenesis and cardiac rhythm in AF . METHODS We prospect ively studied 130 patients with newly diagnosed non-valvular AF in absence of antithrombotic therapy . Determinations of C-reactive protein ( CRP ) and thrombin-antithrombin complex ( TAT ) plasma levels , along with a transesophageal echocardiogram  were performed in all the patients at admission . RESULTS Mean age of the group was 67+/-14 years .  CRP levels were significantly elevated in AF patients versus controls ( matched by age , gender and cardiovascular risk factors ) ( 1.0+/-1.8 versus 0.3+/-0.4 mg/dl , respectively , p<0.01 ) . Baseline TAT levels were also significantly elevated in AF patients but no correlation was found between CRP and TAT . At 1-year of follow-up , mean CRP levels were still elevated in patients that remained in AF compared to those who converted to sinus rhythm ( 1.2+/-1.8 compared to 0.5+/-1.5 mg/dl , p=0.03 ) . CRP was the only biochemical predictor of sinus rhythm maintenance at 1-year follow-up independently of clinical ( including adjustment for risk factors and antiarrhythmic drugs ) , biochemical and echo parameters . CONCLUSIONS There is evidence for the presence of inflammation in patients with non-valvular AF , which is not related to activation of the coagulation cascade . The persistence of inflammation is associated with chronic AF at 1-year follow up Background —It has been suggested that inflammation can have a role in the development of atrial arrhythmias after cardiac surgery and that a genetic predisposition to develop postoperative complications exists . This study was conceived to verify if a potential genetic modulator of the systemic inflammatory reaction to cardiopulmonary bypass ( the −174 G/C polymorphism of the promoter of the Interleukin-6 gene ) has a role in the pathogenesis of postoperative atrial fibrillation ( AF ) . Patients and Results —In 110 primary isolated coronary artery bypass patients the −174G/C Interleukin-6 promoter gene variant was determined . Interleukin-6 , fibrinogen and C-reactive protein plasma levels were determined preoperatively , 24 , 48 , and 72 hours after surgery and at discharge . Heart rate and rhythm were continuously monitored for the first 36 to 48 hours ; daily 12-lead electrocardiograms were performed thereafter until discharge . GG , CT , and CC genotypes were found in 62 , 38 , and 10 patients , respectively . Multivariate analysis ( which included genotype , age , sex , and classical risk factors for AF ) identified the GG genotype as the only independent predictor of postoperative AF . The latter occurred in 33.9 % of GG versus 10.4 % of non-GG patients ( hazard ratio 3.25 , 95%CI 1.23 to 8.62 ) . AF patients  had higher blood levels of Interleukin-6 and fibrinogen after surgery ( P < 0.001 for difference between the area under the curve ) . Conclusion —The −174G/C Interleukin-6 promoter gene variant appears to modulate the inflammatory response to surgery and to influence the development of postoperative AF . These data suggest an inflammatory component of postoperative atrial arrhythmias and a genetic predisposition to this complication BACKGROUND Atrial fibrillation ( AF ) is a very common cardiac arrhythmia , and is associated with an increased mortality in patients with hypertension . Whether the best therapeutic approach for these patients is to restore sinus rhythm ( SR ) or to adequately control the ventricular rate is still controversial . The aim of this study is to compare both strategies in patients with hypertension . METHODS AND RESULTS Two hundred and twenty-one patients with hypertension and AF of duration > 48 h were r and omly assigned to either the rhythm ( n=155 ) or rate ( n=66 ) control group . Exercise capacity was improved in the rhythm control group in the 1st year of the study ( p<0.0001 ) . There were no statistically significant differences in the embolic event rate and the total mortality between the 2 groups at the end of the study ( p = NS ) . CONCLUSIONS Although restoring and maintaining SR had a beneficial effect on exercise capacity in patients with hypertension and AF , no significant difference was found in terms of the total mortality and the embolic event rates . Thus , rate control is an acceptable primary strategy in patients with AF and hypertension OBJECTIVES This study was design ed to compare two treatment strategies in patients with atrial fibrillation(AF ) :  rhythm-control ( restoration and maintenance of sinus rhythm ) and rate-control ( pharmacologic or invasive rate-control and anticoagulation ) . BACKGROUND Atrial fibrillation is the most common arrhythmia . It is unclear whether a strategy of rhythm- or rate-control is better in terms of mortality , morbidity , and quality of life . METHODS The Strategies of Treatment of Atrial Fibrillation ( STAF ) multicenter pilot trial r and omized 200 patients ( 100 per group ) with persistent AF to rhythm- or rate-control .  The combined primary end point was a combination of death , cardiopulmonary resuscitation , cerebrovascular event , and systemic embolism . RESULTS After 19.6 + /- 8.9 months ( range 0 to 36 months ) there was no difference in the primary end point between rhythm-control ( 9/100 ; 5.54%/year ) and rate-control ( 10/100 ; 6.09%/year ; p = 0.99 ) . The percentage of patients in sinus rhythm in the rhythm-control group after up to four cardioversions during the follow-up period ( rate-control group ) was 23 % ( 0 % ) at 36 months . Eighteen primary end points occurred in atrial fibrillation ; only one occurred in sinus rhythm ( p = 0.049 ) . CONCLUSIONS The STAF pilot study showed no differences between the two treatment strategies in all end points except hospitalizations . These data suggest that there was no benefit in attempting rhythm-control in these patients with a high risk of arrhythmia recurrence . It remains unclear whether the results in the rhythm-control group would have been better if sinus rhythm had been maintained in a higher proportion of patients , as all but one end point occurred during AF Background — Atrial arrhythmias are common early after atrial fibrillation ( AF ) ablation . We hypothesized that empirical antiarrhythmic drug ( AAD ) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias . Methods and Results — We r and omized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy ( AAD group ) or no antiarrhythmic therapy ( no-AAD group ) for the first 6 weeks after ablation . In the no-AAD group , only atrioventricular nodal blocking agents were prescribed . All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks . The primary end point of the study was a composite of ( 1 ) atrial arrhythmias lasting more than 24 hours ; ( 2 ) atrial arrhythmias associated with severe symptoms requiring hospital admission , cardioversion , or initiation/change of antiarrhythmic drug therapy ; and ( 3 ) intolerance to antiarrhythmic agent requiring drug cessation .  Of 110 enrolled patients ( age 55±9 years , 71 % male ) , 53 were r and omized to AAD and 57 to no-AAD . There was no difference in baseline characteristics between groups . During the 6 weeks after ablation , fewer patients reached the primary end point in the AAD compared with the no-AAD group ( 19 % versus 42 % ; P=0.005 ) . There remained fewer events in the AAD group ( 13 % versus 28 % ; P=0.05 ) when only end points of AF > 24 hours , arrhythmia-related hospitalization , or electrical cardioversion were compared . Conclusions — AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinical ly significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management Atrial fibrillation ( AF ) is a common arrhythmia , after cardiac surgery , and it is associated with a twofold increase in cardiovascular mortality and morbidity . Reperfusion injury and inflammation associated with cardiac surgery are thought to be involved in its pathogenesis . Heat shock proteins ( HSPs ) are a family of chaperone proteins which assist in preservation of cellular integrity by maintaining proteins in their correctly folded state . The aim of this study was to investigate pre-postoperative heat shock protein70 ( HSP70 ) and high-sensitivity C-reactive protein in serum from patients in preoperative sinus rhythm . We prospect ively screened 45 consecutive patients admitted to the hospital for elective coronary artery bypass surgery ( CABG ) .  Electrocardiogram characteristics and cardiovascular risk profile were documented . Pre- and postoperative blood sample s were collected . HSP70 value was 8.9 + /- 4.8 ng/mL in Group A ( study group ) preoperatively and decreased to 7.7 + /- 7.0 ng/mL postoperatively . In contrast , preoperative value of HSP70 was 4.2 + /- 2.2 ng/mL and decreased to 2.7 + /- 2.6 ng/mL postoperatively in Group B ( control group ) . Statistical analysis showed significant difference regarding preoperative HSP70 levels in Group A compared to Group B. To our knowledge , with this study , the association of pre- and postoperative circulating HSP70 with postoperative AF was demonstrated for the first time
Conclusions Our meta- analysis indicates that vitamin C may prevent post-operative atrial fibrillation in some countries outside of the USA , and it may also shorten the duration of hospital stay and ICU stay of cardiac surgery patients .
Vitamin C is an essential nutrient that is safe and inexpensive .
Background Atrial fibrillation ( AF ) , a common arrhythmia contributing substantially to cardiac morbidity , is associated with oxidative stress and , being an antioxidant , vitamin C might influence it .