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Anti-inflammatory drugs in the prevention of post-operative atrial fibrillation: a literature review

  • Homa Nomani
  • Amir Hooshang MohammadpourEmail author
  • Seyed Mohammad Hassan Moallem
  • Amirhossein SahebkarEmail author
Review
  • 42 Downloads

Abstract

Atrial fibrillation (AF) is a serious and common complication following heart surgery. Cardiac surgery triggers inflammation in the heart and makes it susceptible to the incidence of AF. Therefore, anti-inflammatory drugs may reduce the rate of AF incidence in the post-surgery conditions. Immunosuppressant agents, steroidal anti-inflammatory drugs (corticosteroids), non-aspirin non-steroid anti-inflammatory drugs (NSAIDs), colchicine and omega-3 unsaturated fatty acids (n-3 UFA) are drugs with well-known anti-inflammatory properties. The efficacy, safety and other aspects of using these drugs in the prevention of post-operative AF (POAF) have been reviewed here. Studies evaluating the efficacy of colchicine have shown that it could be effective in the prevention of POAF. However, there is a need for additional studies to find a colchicine regimen with optimal efficacy and higher tolerability. The use of corticosteroids may also be of value based on the most of meta-analyses. In the case of n-3 polyunsaturated fatty acids and NSAIDs, current data fail to support their efficacy in POAF prevention. Moreover, perioperative administration of NSAIDs may be associated with some severe safety considerations. Immunosuppressant agents have not been used for the prevention of POAF. Further studies are needed to find the most effective strategy for POAF prevention with the least safety considerations and the highest health benefits.

Keywords

Atrial fibrillation Inflammation Surgery 

Abbreviations

AF

Atrial fibrillation

POAF

Post-operative atrial fibrillation

HF

Heart failure

CAD

Coronary artery diseases

CABG

Coronary artery bypass graft

CRP

C-reactive protein

TNF-α

Tumor necrosis factor-α

SAIDs

Steroid anti-inflammatory drugs

NSAID

Non-steroid anti-inflammatory drugs

RCT

Randomized clinical trials

n-3 PUFA

Omega3 polyunsaturated fatty acids

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest in this study.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.School of PharmacyMashhad University of Medical SciencesMashhadIran
  2. 2.Department of Clinical Pharmacy, School of PharmacyMashhad University of Medical SciencesMashhadIran
  3. 3.Pharmaceutical Research Center, Pharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran
  4. 4.School of MedicineMashhad University of Medical SciencesMashhadIran
  5. 5.Halal Research Center of IRIFDATehranIran
  6. 6.Neurogenic Inflammation Research CenterMashhad University of Medical SciencesMashhadIran
  7. 7.Biotechnology Research Center, Pharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran

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