The effect of proton-pump inhibitors on development of arrhythmia and hypomagnesaemia after off-pump coronary artery bypass surgery

Introduction: Long-term use of proton-pump inhibitors (PPI) can result in hypomagnesaemia and arrhythmia.The aim of this study was to compare the effect of PPI and histamine ۲-receptor antagonists (H۲RA) on the incidence of hypomagnesaemia and arrhythmia in patients following off-pump coronary artery bypass surgery (CABG).Method: In this randomized-controlled clinical trial ۲۹۰ patients admitted ICU after off-pump CABG were randomly divided into two groups of H۲RA (n=۱۴۵) and PPI (n=۱۴۵).For patients in the H۲RA group, ۵۰ mg intravenous ranitidine was prescribed every ۸hrs after during the nothing by mouth (NPO) period followed by ۴۰mg famotidine tablet after starting the oral regimen (PO). The PPI group received ۴۰ mg pantozol IV injections every ۱۲ hrs during the NPO period and ۴۰mg pantozol tablets once daily after becoming PO.The patients were investigated for development of hypomagnesaemia and associated arrhythmia.Results: In total ۲۷۱ patients with the mean age of ۵۹.۳±۱۰ yrs completed the study (female/male=۳۲.۸%). Hypomagnesaemia occurred in ۶۰.۱% of the patients; ۷۶ (۵۶.۷%) in the H۲RA group and ۸۷ (۶۳.۵%) in the PPI group (P=۰.۲۴۵) whereas arrhythmia had a prevalence of ۱۲ (۹.۶%) and ۱۵ (۱۱.۱%), respectively (P=۰.۶۹۰). The mean time of occurrence of hypomagnesaemia and arrhythmia were ۱.۷۵±۱.۰۸ and ۳.۰±۰.۹ days after the operation in the H۲RA group and ۱.۴۷±۰.۷ and ۲.۹±۱.۵ days in the PPI group, respectively (P=۰.۱۱۱ and P=۰.۸۹۷).Conclusion: Our study revealed that the short-term use of PPIs does not result in higher rates of hypomagnesaemia and associated arrhythmia in comparison to H۲RAs after off-pump CABG.

Keywords:

Proton-pump inhibitors (PPI) , hypomagnesaemia , arrhythmia , Off-Pump CABG , Histamine ۲-receptor antagonist (H۲RA)