Sole And Combined Vitamin C Supplementation Can Prevent Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review And Meta-analysis Of Randomized Controlled Trials

Summary:We undertook a systematic review and meta-analysis to evaluate the effect of vitamin C supplementation(vitamin C solely or adjunct to other therapy)on prevention of postoperative atrial fibrillation(POAF)in patients after cardiac surgery.PubMed,EMbase,Web of Science and Cochrane Library were systematically searched to identify randomized controlled trials(RCTs)assessing the effect of vitamin C supplementation in adult patients undergoing cardiac surgery,and the meta-analysis was performed with random-effects model.Thirteen RCTs involving 1956 patients were included.Pooling estimate showed a significantly reduced incidence of POAF(RR 0.68,95% CI 0.54 to 0.87,P = 0.002)both in vitamin C solely(RR 0.75,95% CI 0.63 to 0.90,P = 0.002)and adjunct to other therapy(RR 0.32,95% CI 0.20 to 0.53,P < 0.001).The results remain stable and robust in subgroup and sensitivity analyses,and trial sequential analysis also confirmed the evidence was sufficient and conclusive.Additionally,vitamin C could significantly decrease ICU length of stay(WMD-0.24 days,95% CI-0.45 to-0.03,P =0.023),HLOS(WMD-0.95 days,95% CI-1.64 to-0.26,P = 0.007),and risk of adverse events(RR 0.45,95% CI 0.21 to 0.96,P = 0.039).Use of vitamin C solely and adjunct to other therapy can prevent POAF in patients undergoing cardiac surgery and should be recommended for patients receiving cardiac surgery for prevention of POAF.