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Botox may prevent AF after CABG surgery

Botox may prevent arrhythmias when injected into fat surrounding the heart after coronary artery bypass surgery (CABG), according to research published recently in Circulation: Arrhythmia and Electrophysiology.

In two Russian hospitals, researchers randomly assigned 60 patients to receive Botulinum toxin, commonly known as Botox, or saline injections. The injections were made in the four major epicardial fat pads. To avoid bias, neither patients nor doctors knew whether the injections contained Botox or saline.

Researchers found that:

  • In the 30 days following surgery, those who received Botox injections during heart bypass surgery had a 7% chance of developing atrial fibrillation (AF), compared to 30% chance in patients who received saline.
  • One year after surgery, none of the patients who received Botox had AF, compared to 27% of the patients who received saline.
  • No complications from the Botox injections were reported. But complications from the bypass surgery were similar in both groups, including time in intensive care and on mechanical ventilation, and infection rate.

The results must be replicated in larger studies before Botox injections are routinely used to prevent AF after bypass surgery, researchers said. If confirmed in heart bypass patients, Botox injections could also help prevent AF in people undergoing valve repair or replacement. About half of those patients will develop AF after surgery.

Professor Jonathan S Steinberg (University of Rochester, USA)

Professor Jonathan S Steinberg (University of Rochester, USA)

“About a third of all patients undergoing bypass surgery will develop AF, putting them at higher risk for cardiovascular complications,” said Professor Jonathan S Steinberg (University of Rochester, New York, USA), senior study author. “AF is also always associated with lengthened hospitalisation and that means increased healthcare costs.”

“This first-in-man study has opened a whole new line of thinking and research,” Professor Steinberg added. “In the near future, Botox injections may become the standard of care for heart bypass and valve patients, but we’re not quite there yet.”

Speaking to BJC Arrhythmia Watch, Professor Steinberg said: “The original series was conducted at two centres in Russia and another study is being done at several Russian centres. We are in negotiation with a sponsor to next perform a series of clinical trials that will be conducted in Europe and in the USA.

“There are no known adverse effects, based on clinical and animal studies…[the technique is] not expensive and with proper instruction, a cardiac surgeon should have no problem,” he added.


1. Pokushalov E, Kozlov B, Romanov A, et al. Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: one year follow up of a randomized pilot study. Circ Arrhythm Electrophysiol 2015.

Published on: November 24, 2015

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