Special Issue: Advances in Cardiometabolic and Coronary Artery Disease Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents Jimmy T. Efird 1 , Charulata Jindal 1 , Andy C. Kiser 2 , Shahab A. Akhter 2 , Patricia B. Crane 3 , Alan P. Kypson 4 , Aaron L. Sverdlov 5 , Stephen W. Davies 6 , Linda C. Kindell 2 and Ethan J. Anderson 7 Abstract Background: Postoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass graft (CABG) surgery. This arrhythmia occurs more frequently among patients who receive perioperative inotropic therapy (PINOT). Administration of nitrates with antiplatelet agents reduces the conversion rate of cyclic guanosine monophosphate to guanosine monophos- phate. This process is associated with increased concentrations of free radicals, catecholamines, and blood plasma volume. We hypothesized that patients undergoing CABG surgery who receive PINOT may be more susceptible to POAF when nitrates are administered with antiplate- let agents. 1 Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia 2 Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA 3 Office of the Dean, College of Nursing, East Carolina University, Greenville, NC, USA 4 Cardiac Surgical Specialists, REX Health Care, University of North Carolina, Raleigh, NC, USA 5 Priority Clinical Centre for Cardiovascular Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia 6 Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA 7 Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA Corresponding author: Jimmy T. Efird, Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia. Email: jimmy.efird@stanfordalumni.org Journal of International Medical Research 2018, Vol. 46(8) 3183–3194 ! The Author(s) 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0300060518773934 journals.sagepub.com/home/imr Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).