Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery: a meta-analysis of published randomized controlled trials

Abstract

BackgroundAtrial fibrillation is a common complication after cardiac surgery. The aim of this study is to evaluate whether N-acetylcysteine (NAC) could prevent postoperative atrial fibrillation (POAF).MethodsPubMed, Embase and Cochrane Center Register of Controlled Trials were searched from the date of their inception to 1 July 2013 for relevant randomized controlled trials (RCTs), in which NAC was compared with controls for adult patients undergoing cardiac surgery. Outcome measures comprised the incidence of POAF, all-cause mortality, length of intensive care unit (ICU) stay, hospital length of stay, and the incidence of cerebrovascular events. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity.ResultsWe retrieved ten studies enrolling a total of 1026 patients. Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to 0.77; P < 0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93; P = 0.03) compared with controls, but failed to reduce the stay in ICU and overall stay in hospital. No difference in the incidence of cerebrovascular events was observed.ConclusionsProphylactic use of NAC could reduce the incidence of POAF and all-cause mortality in adult patients undergoing cardiac surgery. However, larger RCTs evaluating these and other postoperative complication endpoints are needed.

Postoperative Atrial Fibrillation in Liver Transplantation

“…Amiodarone is another useful agent in prevention of POAF, particularly when beta blockers cannot be used (28). Other drugs such as colchicine, statins, magnesium, nonsteroidal anti-inflammatory and other agents have shown variable effects (1,(28)(29)(30)(31). Management in POAF after LT faces not only the lack of trials or guidelines, but also several unique challenges.…”

Postoperative atrial fibrillation: Is there a need for prevention?

“…1,16 Probably out of concern that these complications could occur there has been increasing interest in nonantiarrhythmic medications shown to possess secondary properties of preventing AF after cardiothoracic surgery. [18][19][20][21][22] In a recent double-blind study, 19 we compared atorvastatin to placebo given 1 week before and 1 week after thoracic surgery and found a significant association with its use and the reduction of the composite end point of multiple complications, including POAF, pneumonia, acute respiratory distress syndrome, myocardial infarction, deep venous thrombosis, and in-hospital mortality. Our study lacked statistical power to show that atorvastatin specifically reduced POAF specifically (despite a 50% difference between the trial arms), but a beneficial effect was found by others in a larger study of patients undergoing cardiac surgery.…”

“…1 More potent antioxidants such as N-acetylcysteine when used alone or in combination with other medications have been shown to decrease serum levels of oxidative stress markers and reduced AF after cardiac surgery. 20,21 A recent trial of antioxidant supplementation with oral n-3 polyunsaturated fatty acids started 1 week before on-pump cardiac surgery and then combined with vitamins C and E added 2 days before surgery showed that this regimen was associated with a significant reduction POAF as well as in plasma and atrial tissue markers of oxidative stress and inflammation. 22…”

Vitamin C for the Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

“…Apart from corticosteroids, drugs that are known to target oxidative stress include N-acetylcysteine, polyunsaturated fatty acids, and vitamins C (vitC) and E. [12][13][14][15] In the present meta-analysis, we sought to evaluate the strength of evidence for vitC supplementation in cardiac surgery as prophylaxis for postoperative AF.…”