Oxidative Status, Inflammation, and Postoperative Atrial Fibrillation With Metoprolol vs Carvedilol or Carvedilol Plus N‐Acetyl Cysteine Treatment

Abstract

Background: Atrial fibrillation is associated with inflammation and oxidative stress. Hypothesis: Carvedilol and N-acetyl cysteine (NAC) combination decreases inflammation, oxidative stress, and postoperative atrial fibrillation (POAF) rates more than metoprolol or carvedilol. Methods: Preoperative and postoperative total oxidative stress (TOS), total antioxidant capacity (TAC), and white blood cells (WBC) were measured in metoprolol, carvedilol, or carvedilol plus NAC groups, and association with POAF was evaluated. Results: Preoperative TAC, TOS, and WBC levels were similar among the groups. Postoperative TAC levels were lower in the metoprolol group compared with the carvedilol group (1.0 vs 1.4) or the carvedilol plus NAC group (1.0 vs 1.9) and were also lower in the carvedilol group compared with the carvedilol plus NAC group (all P < 0.0001). Postoperative TOS levels were higher in the metoprolol group as compared with the carvedilol (29.6 vs 24.2; P < 0.0001) or the carvedilol plus NAC groups (P < 0.0001), and were also higher in the carvedilol group as compared with the carvedilol plus NAC group (24.2 vs 19.3; P < 0.0001). Postoperative WBC counts were lower in the carvedilol plus NAC group compared with the metoprolol group (12.9 vs 14.8; P = 0.004), were similar between the carvedilol and the metoprolol groups (13 vs 14.8) and between the carvedilol plus NAC group and the carvedilol group (both P > 0.05). Postoperative TAC, TOS, and WBC were associated with POAF. Conclusions: Carvedilol plus NAC reduced oxidative stress and inflammation compared with metoprolol and decreased oxidative stress compared with carvedilol. Postoperative TAC, TOS, and WBC were associated with POAF. IntroductionCardiopulmonary bypass may cause oxidative stress and inflammation 1 processes that have been shown to be associated with atrial fibrillation.2 -5 Carvedilol is a nonselective β-blocker and N-acetyl cysteine (NAC) is a mucolytic agent. These agents have anti-inflammatory and antioxidant properties, 6 -16 and they decreased postoperative atrial fibrillation (POAF) rates in previous studies.2,17 -22 In a randomized study, we have shown that carvedilol plus NAC decreased POAF incidence compared with metoprolol or carvedilol.23 However, it is not known whether the effect of carvedilol and NAC is associated with changes in the levels of oxidative markers or whether there is a correlation between these markers and the development of POAF.

Improved oxidative status in major abdominal surgery patients after N-acetyl cystein supplementation

“…To date, only a few studies have examined the effects of NAC and antioxidant vitamins on disease and reported beneficial effects of these combined therapies [ 26 , 27 ], however, the principal reason behind the lower or unaltered levels of these vitamins in the current study remains unknown. A recent study has shown that NAC administration during high-intensity exercise did not change blood glutathione levels but diminished lipid peroxidation [ 28 ], and there is also evidence regarding the altered pre-operative and post-operative total oxidative stress and total antioxidant capacities following NAC treatment [ 29 ]. Therefore total oxidative stress and total antioxidant capacities should be measured in future studies to elucidate the antioxidant mechanisms that are associated with NAC action.…”

Carvedilol Could Ameliorate Acetaminophen Overdose Hepatotoxicity. Endogenous H2S Contributes Such Effect: A Comparative Biochemical Evaluation

“…In support of antioxidant activity of CVD, Ozaydin et al, [35] clinically detected that CVD and N-acetyl cysteine reduced oxidative stress and inflammation compared with metoprolol and decreased oxidative stress compared with CVD alone. Recently, Araújo Júnior et al, [36] in rat model of ethanol-induced liver injury reported that CVD treatment was associated with reduced levels of AST, ALT, triglyceride, MDA, and proinflammatory cytokines and increased levels of the anti-inflammatory cytokine IL-10 and GSH compared to the alcohol-only group Interestingly, animals received CVD and H 2 S blocker (PAG) showed deterioration of the effect of CVD manifested as significantly higher serum levels of ALT, AST and MDA levels with reduced activity levels of antioxidant enzymes in liver homogenates compared to animals received CVD alone despite being significantly better than animals received APAP alone.…”

Monocyte–platelet aggregates and CD11b expression as markers for thrombogenicity in atrial fibrillation

“…However, this requires further studies. Between some new treatment approaches [43,44], there is already some evidence for possible beneficial roles of anti-inflammatory therapies for prevention of the development of AF [45] as well. Colchicine was shown to be able to reduce the rate of recurrences of AF after pulmonary vein isolation [46], whereas corticosteroids significantly reduce the risk of postoperative AF [7,47,48].…”