Response to Letter Regarding Article,“Does Sodium Nitroprusside

Correspondence
Response to Letter Regarding Article, “Does
Sodium Nitroprusside Decrease the Incidence of
Atrial Fibrillation After Myocardial
Revascularization? A Pilot Study”
Disclosures
None.
Raif Cavolli, MD
Department of Cardiovascular Surgery
American Hospital
Tirana, Albania
We are thankful to Dr Singh for his interest in our study.1
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1. We agree with Dr Singh that, in our study, patients had relatively
preserved left ventricular systolic functions. However, our limited
resources did not allow for further enrollment beyond our
predetermined sample size.
2. Previous reports suggest that ␤-blockers suppress atrial fibrillation (AF) after surgery.2 Dr Singh requests information on the
group of patients that had ␤-blocker withdrawal during the
postoperative period. The rate of ␤-blocker withdrawal in this
study was low (3 [4.8%] of the 63). No significant difference was
found in the rates of postoperative atrial fibrillation when comparing
the 2 patients randomized to SNP and the 1 patient randomized to
placebo (5.8% versus 3.4%, respectively; P⬎0.20). However, because of the small size of this group, power was not sufficient to
detect a significant effect. Amiodarone was administered only
when patients had postoperative AF, and postoperative statins
were used routinely at our clinic. We did not use digoxin in this
study.
3. Atrial arrhythmia after cardiac surgery may have important
consequences including cerebrovascular events,3 although during
our study none of the patients showed symptoms of cerebrovascular events.
Kaan Kaya, MD
Sebnem Erturk, MD
Oguz Mehmet, MD
Department of Cardiovascular Surgery
Ulus Hospital
Ankara, Turkey
Alp Aslan, MD
Ozan Emiroglu, MD
Ozge Korkmaz, MD
Department of Cardiovascular Surgery
Kavaklidere Umut Hospital
Ankara, Turkey
Refik Tasoz, MD
Umit Ozyurda, MD
Department of Cardiovascular Surgery
Ankara University, Medical School
Ankara, Turkey
References
1. Cavolli R, Kaya K, Aslan A, Emiroglu O, Erturk S, Korkmaz O, Oguz M,
Refik T, Tasoz R, Ozyurda U. Does sodium nitroprusside decrease the
incidence of atrial fibrillation after myocardial revascularization? a pilot
study. Circulation. 2008;118:476 – 481.
2. Aerra V, Kuduvalli M, Moloto AN, Srinivasan AK, Grayson AD, Fabri
BM, Oo AY. Does prophylactic sotalol and magnesium decrease the
incidence of atrial fibrillation following coronary artery bypass surgery: a
propensity-matched analysis. J Cardiothorac Surg. 2006;1:6.
3. Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmia. Ann Thorac Surg. 1993;56:539 –549.
In response to Dr Singh, our study suggests that SNP has a
beneficial effect in preventing AF after coronary artery bypass
grafting. It is also the first clinical trial to evaluate the efficacy of
SNP in prevention of the post– coronary artery bypass grafting AF.
This study provides a strong platform for conducting a large-scale
randomized trial and will make an important contribution to metaanalyses assessing the role of SNP in the treatment of this most
common arrhythmia after coronary artery bypass grafting.
(Circulation. 2009;119:e487.)
© 2009 American Heart Association, Inc.
Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.108.829051
e487
Response to Letter Regarding Article, ''Does Sodium Nitroprusside Decrease the Incidence
of Atrial Fibrillation After Myocardial Revascularization? A Pilot Study''
Raif Cavolli, Kaan Kaya, Sebnem Erturk, Oguz Mehmet, Alp Aslan, Ozan Emiroglu, Ozge
Korkmaz, Refik Tasoz and Umit Ozyurda
Downloaded from http://circ.ahajournals.org/ by guest on October 12, 2016
Circulation. 2009;119:e487
doi: 10.1161/CIRCULATIONAHA.108.829051
Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231
Copyright © 2009 American Heart Association, Inc. All rights reserved.
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