Safety and Efficacy of Tocotrienols in Post-CABG Atrial Fibrillation

At present, guidelines exist in Europe and the USA on the pharmacological prophylaxis and management of postoperative AF. However, these are subject to a number of limitations including treatment failure, toxicity and pro-arrhythmogenicity. Hence, efforts have been made to develop alternative preventive strategies. The understanding of the role of oxidative stress as a mechanism for AF development has made way for antioxidant vitamins as novel therapeutic and preventive agents.

In view of emerging evidence on the HMG-CoA reductase inhibitory role in the incidence of AF and established inhibitory properties of tocotrienols, we postulate that supplementation with tocotrienols may exert therapeutic advantage in the safety endpoints of post-CABG. The modulation of oxidative stress status and anti-inflammatory via HMG-CoA reductase inhibition may work synergistically in affecting the incidence of AF post-CABG.

Inclusion criteria

• Males or females
• More than 18 years of age
• Elective, on-pump surgery of coronary artery revascularization, isolated or combined valve surgery

Exclusion criteria

• Less than 18 years of age
• Refusal to have surgery
• Urgent or emergency surgery
• Off-pump surgery
• Poor LV (EF < 30%)
• Inability to give informed consent
• Documented allergy to palm oil or Vitamin E
• Documented AF or any form of arrhythmia pre-operatively
• Currently on or indicated for long-term corticosteroid treatment
• Patients who have been included in any other clinical trial within the previous three months
• Patients who are on supplementation of Vitamin E or other potent anti-oxidants up to 1 month before randomisation