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. 2024 Aug;47(8):1087-1095.
doi: 10.1111/pace.15038. Epub 2024 Jun 30.

Empagliflozin to prevent post-operative atrial fibrillation in patients undergoing coronary artery bypass graft surgery: Rationale and design of the EMPOAF trial

Maryam Aghakouchakzadeh  1 , Kaveh Hosseini  1   2 , Majid Haghjoo  3 , Parastoo Mirzabeigi  4 , Masih Tajdini  1   2 , Azita H Talasaz  1   5 , Arash Jalali  2 , Amir Askarinejad  6 , Erfan Kohansal  6 , Behnam Hedayat  1 , Ehsan Parvas  1 , Ali Bozorgi  1 , Jamshid Bagheri  1 , Nader Givtaj  7 , Naser Hadavand  6 , Alireza Hajighasemi  1 , Seyed Hossein Ahmadi Tafti  1 , Saeid Hosseini  7 , Parham Sadeghipour  8 , Hessam Kakavand  4   6
Affiliations

Empagliflozin to prevent post-operative atrial fibrillation in patients undergoing coronary artery bypass graft surgery: Rationale and design of the EMPOAF trial

Maryam Aghakouchakzadeh et al. Pacing Clin Electrophysiol. 2024 Aug.

Abstract

Background: Postoperative atrial fibrillation (POAF) is one of the most common types of acute AF and can complicate the treatment course of approximately one third of patients undergoing cardiac surgery. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are among the newest antidiabetic drugs which can be therapeutic options for preventing POAF by different mechanisms.

Methods: Empagliflozin to Prevent POAF (EMPOAF) is an interventional, investigator-initiated, double-blind, placebo-controlled, multicenter, randomized controlled trial which will be conducted in two referral teaching cardiology hospitals in Tehran. Four-hundred ninety-two adult patients who are scheduled for elective isolated coronary artery bypass graft (CABG) surgery will be randomly assigned to one of the groups of intervention (empagliflozin 10 mg daily) or placebo starting at least 3 days before surgery until discharge. Key exclusion criteria are a history of diabetes mellitus, AF, ketoacidosis, or recurrent urinary tract infections along with severe renal or hepatic impairment, unstable hemodynamics, and patients receiving SGLT2 inhibitors for another indication. The primary outcome will be the incidence of POAF. Key secondary endpoints will be the composite rate of life-threatening arrhythmias, postoperative acute kidney injury, hospitalization length, in-hospital mortality, stroke, and systemic embolization. Key safety endpoints will be the rate of life-threatening and/or genitourinary tract infections, hypoglycemia, and ketoacidosis.

Conclusions: EMPOAF will prospectively evaluate whether empagliflozin 10 mg daily can reduce the rate of POAF in patients undergoing elective CABG. Enrolment into this study has started by November 2023 and is expected to be ended before the end of 2025.

Keywords: CABG; SGLT2 inhibitors; atrial fibrillation; cardiac surgery; empagliflozin; post‐operative AF.

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References

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