Atrial fibrillation (AF) is the most common cardiac severe arrhythmia globally and is
associated with an increased risk of mortality and morbidity, with a loss of 6.0 million
disability-adjusted life-years worldwide in 2017, conferring 0.24% of total
disability-adjusted life-years globally. Due to the absence of knowledge of AF pathogenesis,
currently, available therapies do not prevent AF onset or progression in 85% of patients.
Despite the identification of novel druggable targets that are involved in the pathogenesis
of AF, the translation of these findings to clinical drug studies is limited.
Postoperative atrial fibrillation (POAF) is the most common type of secondary AF. The
incidence of POAF after coronary artery bypass grafting (CABG) is approximately 30%. About
16% of patients developed POAF in cardiac surgery even with the international guideline
recommended perioperative beta-blocker intervention.
Remimazolam is a newly approved benzodiazepine sedative indicated for the induction and
maintenance of procedural sedation in adults, with significantly reduced sedation and
recovery time. It was also found to be with an anti-inflammatory effect and therefore might
have an impact on POAF since AF is closely related to the inflammatory response of myocardial
tissue and inflammatory factors such as TNF-α. So, the RePAF trial intends to explore whether
remimazolam application in induction and maintenance for general anesthesia during cardiac
surgery can reduce the incidence of POAF in patients with CABG, and the effect on the
postoperative plasma levels of inflammatory factors and stress factors.