Trial Outcomes & Findings for Prophylaxis to Reduce Postoperative Atrial Fibrillation in Cardiac Surgery (NCT NCT00953212)

NCT ID: NCT00953212

Last Updated: 2018-04-26

Results Overview

Atrial fibrillation is a common complication of cardiac surgery which is associated with increased morbidity, length of stay and cost. The opportunity to use ascorbic acid for AF prophylaxis is attractive because of its low side effect profile, wide acceptance and low cost. This prospective, randomized trial used a 2 X 2 factorial design to determine whether prophylactic ascorbic acid alone, ascorbic acid with amiodarone, or amiodarone alone, when given along with beta blockers would decrease the incidence of postoperative AF in adult cardiac surgery when compared with beta blockers alone, all combinations failed to show any difference between the four groups. While there have been trials that have shown the addition of amiodarone to beta-blockers to be more effective, this analysis does not support that conclusion.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

304 participants

Primary outcome timeframe

5 postoperative days

Results posted on

2018-04-26

Participant Flow

Participant milestones

Participant milestones
Measure
Beta Blockers, Ascorbic Acid and Amiodarone
beta blockers: metoprolol 25mg by mouth every 6 hours amiodarone: amiodarone 600mg by mouth evening before surgery amiodarone 600mg by mouth morning of surgery amiodarone 400mg by mouth every 12 hours for 3 days postoperatively ascorbic acid: ascorbic acid 2,000mg by mouth evening before surgery ascorbic acid 2,000mg by mouth morning of surgery ascorbic acid 1,000mg by mouth every 12 hours for 5 postoperative days
Beta Blockers and Ascorbic Acid
Beta Blockers and Ascorbic Acid beta blockers: metoprolol 25mg by mouth every 6 hours ascorbic acid: ascorbic acid 2,000mg by mouth evening before surgery ascorbic acid 2,000mg by mouth morning of surgery ascorbic acid 1,000mg by mouth every 12 hours for 5 postoperative days
Beta Blockers and Amiodarone
Beta Blockers and Amiodarone beta blockers: metoprolol 25mg by mouth every 6 hours amiodarone: amiodarone 600mg by mouth evening before surgery amiodarone 600mg by mouth morning of surgery amiodarone 400mg by mouth every 12 hours for 3 days postoperatively
Beta Blockers Alone
Beta Blockers alone beta blockers: metoprolol 25mg by mouth every 6 hours
Overall Study
STARTED
76
74
78
76
Overall Study
COMPLETED
76
74
78
76
Overall Study
NOT COMPLETED
0
0
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Prophylaxis to Reduce Postoperative Atrial Fibrillation in Cardiac Surgery

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Group A
n=76 Participants
Beta Blockers, Ascorbic Acid and Amiodarone beta blockers: metoprolol 25mg by mouth every 6 hours amiodarone: amiodarone 600mg by mouth evening before surgery amiodarone 600mg by mouth morning of surgery amiodarone 400mg by mouth every 12 hours for 3 days postoperatively ascorbic acid: ascorbic acid 2,000mg by mouth evening before surgery ascorbic acid 2,000mg by mouth morning of surgery ascorbic acid 1,000mg by mouth every 12 hours for 5 postoperative days
Group B
n=74 Participants
Beta Blockers and Ascorbic Acid beta blockers: metoprolol 25mg by mouth every 6 hours ascorbic acid: ascorbic acid 2,000mg by mouth evening before surgery ascorbic acid 2,000mg by mouth morning of surgery ascorbic acid 1,000mg by mouth every 12 hours for 5 postoperative days
Group C
n=78 Participants
Beta Blockers and Amiodarone beta blockers: metoprolol 25mg by mouth every 6 hours amiodarone: amiodarone 600mg by mouth evening before surgery amiodarone 600mg by mouth morning of surgery amiodarone 400mg by mouth every 12 hours for 3 days postoperatively
Group D
n=76 Participants
Beta Blockers alone beta blockers: metoprolol 25mg by mouth every 6 hours
Total
n=304 Participants
Total of all reporting groups
Age, Continuous
64.3 years
STANDARD_DEVIATION 9.6 • n=5 Participants
65.9 years
STANDARD_DEVIATION 9.4 • n=7 Participants
63.9 years
STANDARD_DEVIATION 10.7 • n=5 Participants
33.4 years
STANDARD_DEVIATION 931 • n=4 Participants
61 years
STANDARD_DEVIATION 15 • n=21 Participants
Sex: Female, Male
Female
16 Participants
n=5 Participants
19 Participants
n=7 Participants
19 Participants
n=5 Participants
20 Participants
n=4 Participants
74 Participants
n=21 Participants
Sex: Female, Male
Male
60 Participants
n=5 Participants
55 Participants
n=7 Participants
59 Participants
n=5 Participants
56 Participants
n=4 Participants
230 Participants
n=21 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
Asian
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
Black or African American
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
1 Participants
n=4 Participants
1 Participants
n=21 Participants
Race (NIH/OMB)
White
76 Participants
n=5 Participants
74 Participants
n=7 Participants
77 Participants
n=5 Participants
75 Participants
n=4 Participants
302 Participants
n=21 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
1 Participants
n=5 Participants
0 Participants
n=4 Participants
1 Participants
n=21 Participants
Smoker
16 Participants
n=5 Participants
19 Participants
n=7 Participants
21 Participants
n=5 Participants
19 Participants
n=4 Participants
75 Participants
n=21 Participants
BMI (mean, SD)
30.6 kg/m^2
STANDARD_DEVIATION 6.1 • n=5 Participants
31.1 kg/m^2
STANDARD_DEVIATION 5.7 • n=7 Participants
27.9 kg/m^2
STANDARD_DEVIATION 4.7 • n=5 Participants
29.5 kg/m^2
STANDARD_DEVIATION 6.2 • n=4 Participants
29.7 kg/m^2
STANDARD_DEVIATION 5.8 • n=21 Participants
Cardiovascular Disease
11 Participants
n=5 Participants
13 Participants
n=7 Participants
14 Participants
n=5 Participants
13 Participants
n=4 Participants
51 Participants
n=21 Participants
Hypertension
69 Participants
n=5 Participants
63 Participants
n=7 Participants
62 Participants
n=5 Participants
65 Participants
n=4 Participants
259 Participants
n=21 Participants
Pre-op Myocardial Infarction
24 Participants
n=5 Participants
30 Participants
n=7 Participants
29 Participants
n=5 Participants
35 Participants
n=4 Participants
118 Participants
n=21 Participants
Diabetes
28 Participants
n=5 Participants
28 Participants
n=7 Participants
23 Participants
n=5 Participants
27 Participants
n=4 Participants
106 Participants
n=21 Participants
Peripheral Vascular Disease
10 Participants
n=5 Participants
8 Participants
n=7 Participants
9 Participants
n=5 Participants
10 Participants
n=4 Participants
37 Participants
n=21 Participants
Chronic Obstructive Pulmonary Disease
10 Participants
n=5 Participants
7 Participants
n=7 Participants
3 Participants
n=5 Participants
11 Participants
n=4 Participants
31 Participants
n=21 Participants
Statin
54 Participants
n=5 Participants
50 Participants
n=7 Participants
52 Participants
n=5 Participants
47 Participants
n=4 Participants
203 Participants
n=21 Participants
Congestive Heart Failure
6 Participants
n=5 Participants
8 Participants
n=7 Participants
4 Participants
n=5 Participants
8 Participants
n=4 Participants
26 Participants
n=21 Participants
Surgery Type - CABG
62 Participants
n=5 Participants
57 Participants
n=7 Participants
55 Participants
n=5 Participants
58 Participants
n=4 Participants
232 Participants
n=21 Participants
Surgery Type - Valve
6 Participants
n=5 Participants
6 Participants
n=7 Participants
13 Participants
n=5 Participants
3 Participants
n=4 Participants
28 Participants
n=21 Participants
Surgery Type - CABG/Valve
6 Participants
n=5 Participants
9 Participants
n=7 Participants
9 Participants
n=5 Participants
12 Participants
n=4 Participants
36 Participants
n=21 Participants
Surgery Type - Other
2 Participants
n=5 Participants
2 Participants
n=7 Participants
1 Participants
n=5 Participants
3 Participants
n=4 Participants
8 Participants
n=21 Participants
Urgent Surgery
68 Participants
n=5 Participants
72 Participants
n=7 Participants
71 Participants
n=5 Participants
73 Participants
n=4 Participants
284 Participants
n=21 Participants

PRIMARY outcome

Timeframe: 5 postoperative days

Population: Number of patients who experienced Atrial Fibrillation post-operatively

Atrial fibrillation is a common complication of cardiac surgery which is associated with increased morbidity, length of stay and cost. The opportunity to use ascorbic acid for AF prophylaxis is attractive because of its low side effect profile, wide acceptance and low cost. This prospective, randomized trial used a 2 X 2 factorial design to determine whether prophylactic ascorbic acid alone, ascorbic acid with amiodarone, or amiodarone alone, when given along with beta blockers would decrease the incidence of postoperative AF in adult cardiac surgery when compared with beta blockers alone, all combinations failed to show any difference between the four groups. While there have been trials that have shown the addition of amiodarone to beta-blockers to be more effective, this analysis does not support that conclusion.

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Occurrence of Post-operative Atrial Fibrillation Requiring Treatment After Open Heart Surgery
50 Participants
56 Participants
58 Participants
48 Participants

SECONDARY outcome

Timeframe: 30 days

Mortality measured within length of hospital stay

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Mortality
1 Participants
1 Participants
1 Participants
0 Participants

SECONDARY outcome

Timeframe: 30 days

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Hospital Length of Stay
7.0 days
Standard Deviation 4.8
6.6 days
Standard Deviation 3.8
6.8 days
Standard Deviation 3.6
6.8 days
Standard Deviation 4.9

SECONDARY outcome

Timeframe: 30 days

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
ICU Length of Stay
2.0 days
Standard Deviation 1.5
1.9 days
Standard Deviation 1.3
2.0 days
Standard Deviation 1.3
1.9 days
Standard Deviation 1.5

SECONDARY outcome

Timeframe: 30 days

Cerebral vascular accident occurring within hospital length of stay

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Stroke
1 Participants
3 Participants
1 Participants
1 Participants

SECONDARY outcome

Timeframe: 30 days

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Low Output Heart Failure
12 Participants
10 Participants
7 Participants
9 Participants

SECONDARY outcome

Timeframe: 30 days

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Postoperative Vasoplegia
17 Participants
15 Participants
14 Participants
16 Participants

SECONDARY outcome

Timeframe: 30 days

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Respiratory Failure Requiring Reintubation
4 Participants
2 Participants
2 Participants
5 Participants

SECONDARY outcome

Timeframe: 30 days

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Bradycardia Necessitating Permanent Pacemaker Placement
0 Participants
2 Participants
0 Participants
2 Participants

SECONDARY outcome

Timeframe: 30 days

Using the Akin definition

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Acute Kidney Injury
19 Participants
13 Participants
22 Participants
11 Participants

SECONDARY outcome

Timeframe: 30 days

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Readmission to ICU for Treatment of Atrial Fibrillation
1 Participants
1 Participants
2 Participants
0 Participants

SECONDARY outcome

Timeframe: 30 days

Outcome measures

Outcome measures
Measure
Amiodarone - Yes
n=154 Participants
Patients who were administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Amiodarone - No
n=150 Participants
Patients who were not administered Amiodarone and Beta Blockers with or without Ascorbic Acid.
Ascorbic Acid - Yes
n=150 Participants
Patients who were administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Ascorbic Acid - No
n=154 Participants
Patients who were not administered Ascorbic Acid and Beta Blockers with or without Amiodarone.
Number of Participants With Readmission to Hospital for Treatment of Atrial Fibrillation
4 Participants
4 Participants
4 Participants
4 Participants

Adverse Events

Group A

Serious events: 1 serious events
Other events: 29 other events
Deaths: 1 deaths

Group B

Serious events: 3 serious events
Other events: 29 other events
Deaths: 1 deaths

Group C

Serious events: 1 serious events
Other events: 21 other events
Deaths: 1 deaths

Group D

Serious events: 1 serious events
Other events: 27 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Group A
n=76 participants at risk
Beta Blockers, Ascorbic Acid and Amiodarone beta blockers: metoprolol 25mg by mouth every 6 hours amiodarone: amiodarone 600mg by mouth evening before surgery amiodarone 600mg by mouth morning of surgery amiodarone 400mg by mouth every 12 hours for 3 days postoperatively ascorbic acid: ascorbic acid 2,000mg by mouth evening before surgery ascorbic acid 2,000mg by mouth morning of surgery ascorbic acid 1,000mg by mouth every 12 hours for 5 postoperative days
Group B
n=74 participants at risk
Beta Blockers and Ascorbic Acid beta blockers: metoprolol 25mg by mouth every 6 hours ascorbic acid: ascorbic acid 2,000mg by mouth evening before surgery ascorbic acid 2,000mg by mouth morning of surgery ascorbic acid 1,000mg by mouth every 12 hours for 5 postoperative days
Group C
n=78 participants at risk
Beta Blockers and Amiodarone beta blockers: metoprolol 25mg by mouth every 6 hours amiodarone: amiodarone 600mg by mouth evening before surgery amiodarone 600mg by mouth morning of surgery amiodarone 400mg by mouth every 12 hours for 3 days postoperatively
Group D
n=76 participants at risk
Beta Blockers alone beta blockers: metoprolol 25mg by mouth every 6 hours
Nervous system disorders
Cerebral Vascular Accident
1.3%
1/76 • Number of events 1
4.1%
3/74 • Number of events 3
1.3%
1/78 • Number of events 1
1.3%
1/76 • Number of events 1

Other adverse events

Other adverse events
Measure
Group A
n=76 participants at risk
Beta Blockers, Ascorbic Acid and Amiodarone beta blockers: metoprolol 25mg by mouth every 6 hours amiodarone: amiodarone 600mg by mouth evening before surgery amiodarone 600mg by mouth morning of surgery amiodarone 400mg by mouth every 12 hours for 3 days postoperatively ascorbic acid: ascorbic acid 2,000mg by mouth evening before surgery ascorbic acid 2,000mg by mouth morning of surgery ascorbic acid 1,000mg by mouth every 12 hours for 5 postoperative days
Group B
n=74 participants at risk
Beta Blockers and Ascorbic Acid beta blockers: metoprolol 25mg by mouth every 6 hours ascorbic acid: ascorbic acid 2,000mg by mouth evening before surgery ascorbic acid 2,000mg by mouth morning of surgery ascorbic acid 1,000mg by mouth every 12 hours for 5 postoperative days
Group C
n=78 participants at risk
Beta Blockers and Amiodarone beta blockers: metoprolol 25mg by mouth every 6 hours amiodarone: amiodarone 600mg by mouth evening before surgery amiodarone 600mg by mouth morning of surgery amiodarone 400mg by mouth every 12 hours for 3 days postoperatively
Group D
n=76 participants at risk
Beta Blockers alone beta blockers: metoprolol 25mg by mouth every 6 hours
Cardiac disorders
Atrial fibrillation
38.2%
29/76 • Number of events 29
39.2%
29/74 • Number of events 29
26.9%
21/78 • Number of events 21
35.5%
27/76 • Number of events 27

Additional Information

Dr. Robert Kramer

Maine Medical Center

Phone: 207-662-2923

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place