Tesis

Efek Allopurinol terhadap Kejadian Fibrilasi Atrium pasca Bedah Pintas Arteri Koroner = Allopurinol Effect on the Incidence of Atrial Fibrillation Following Coronary Artery Bypass Surgery.

Latar belakang : Fibrilasi atrium merupakan aritmia yang paling sering terjadi pasca bedah pintas arteri koroner. Peningkatan stress oksidat if, inflamasi, aktivitas neurohormonal memiliki peran terhadap kejadian fibrilasi atrium pasca bedah pintas arteri koroner. Berbagai strategi farmakologis seperti ant iarit mia, ant iinflamasi, dan antioksidan sudah dipelajari untuk menurun risiko kejadian fibrilasi atrium pasca bedah pintas arteri koroner namun kejadian fibrilasi atrium masih tinggi. Allopurinol memiliki efek ant ioksidan, namun belum ada uji klinis yang mempelajari efek allopurinol terhadap kejadian fibrilasi atrium. Penelit ian ini bertujuan untuk menilai efek allopurinol terhadap kejadian fibrilasi atrium pasca bedah pintas arteri koroner Metode : Uji klinis randomisasi tersamar ganda dilakukan di Rumah Sakit Pembuluh Darah Harapan Kita (RSJPDHK) pada periode April – Mei 2015. Pasien BPAK on-pump elektif yang diseleksi secara consecutive sampling kemudian dibagi menjadi dua kelompok yait u kelompok allopurinol dan kelompok plasebo dengan randomisasi blok. Subyek diberikan allopurinol 600 mg / plasebo dosis tunggal sejak 1 hari sebelum operasi sampai hari ke-5 pasca operasi. Dilakukan pengamatan kejadian fibrilasi atrium pasca operasi sampai pasien pulang dari perawatan. Hasil : Sebanyak 90 subyek diikutsertakan dalam penelit ian, 45 subyek pada masing-masing kelompok. Kejadiaan fibrilasi atrium lebih rendah secara bermakna pada kelompok allopurinol (12 (26,7%) vs 22 (48,9%) p 0,030). Kesimpulan : Pemberian allopurinol perioperatif menurunkan kejadian fibrilasi atrium pasca bedah pintas arteri koroner.
Kata Kunci : Fibrilasi atrium, bedah pintas arteri koroner, stress oksidat if, allopurinol



Background : Atrial fibrillat ion is the most common arrhyt hmias after coronar y artery bypass surgery. Increased oxidative stress, inflammat ion, neurohormonal activit y has a role on the incidence of atrial fibrillat ion after coronary artery bypass surgery. Various pharmacological strategies such as ant iarrhyt hmias, antiinflammatory, and ant ioxidant have been studied to decrease atrial fibrillat ion incident after coronary artery bypass surgery, but the incidence of atrial fibrillat ion is st ill high. Allopurinol has ant ioxidant effects, but there was no clinical trials that studied t he effect of allopurinol on atrial fibrillat ion incidence. The aim of this study to assess allopurinol effect on the atrial fibrillat ion incidence after coronary artery bypass surgery. Methods: A double-blind randomized clinical trial conducted at the National Cardiovascular Center Harapan Kita in Jakarta from April to May 2015. Elect ive on-pump CABG pat ients were selected by consecutive sampling then divided into two groups: allopurinol and placebo groups with block randomizat ion. Subjects given allopurinol 600 mg / placebo single dose since 1 day before surgery unt il the 5th day post-surgery. The incidence of atrial fibrillat ion was observed postoperatively. Results: A total of 90 subjects were included in the study, 45 subjects in each group. Occurrence of atrial fibrillat ion was significant ly lower in the allopurinol group (12 (26.7%) vs 22 (48.9%) p 0,030). Conclusion: Perioperative allopurinol reduced the incidence of atrial fibrillat ion after coronary artery bypass surgery.
Keywords: Atrial fibrillat ion, coronary artery bypass surgery, oxidat ive stress, allopurinol.