Conflict of Interest: None.
Prophylactic High-Dose Oral-N-Acetylcysteine Does Not Prevent Atrial Fibrillation after Heart Surgery
A Prospective Double Blind Placebo-Controlled Randomized Clinical Trial
Article first published online: 3 JUN 2013
©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 10, pages 1211–1219, October 2013
How to Cite
KAZEMI, B., AKBARZADEH, F., SAFAEI, N., YAGHOUBI, A., SHADVAR, K. and GHASEMI, K. (2013), Prophylactic High-Dose Oral-N-Acetylcysteine Does Not Prevent Atrial Fibrillation after Heart Surgery. Pacing and Clinical Electrophysiology, 36: 1211–1219. doi: 10.1111/pace.12190
- Issue published online: 8 OCT 2013
- Article first published online: 3 JUN 2013
- Manuscript Accepted: 18 APR 2013
- Manuscript Revised: 23 MAR 2013
- Manuscript Received: 14 JAN 2013
- postoperative atrial fibrillation;
- coronary artery bypass;
- open heart surgery
Postoperative atrial fibrillation (POAF) following cardiac surgery is a frequent complication with multifactorial etiologies. Recently inflammation due to enhanced oxidative stress has been implicated in its pathogenesis. N-acetylcysteine (NAC) is a promising and novel antioxidant agent. The purpose of this study was to evaluate the efficacy of high-dose oral-NAC for prevention of POAF.
Two hundred and forty patients were randomized in this prospective, double blind placebo-controlled trial to either 1,200-mg oral-NAC two times a day (n = 120) or placebo (n = 120) starting 48 hours before and up to 72 hours after open heart surgery.
The mean age was about 60 years, and 75% were male. Patients in the NAC group were older, with higher percentage of acute coronary syndrome, hypercholesterolemia, and left internal mammary artery use. Coronary involvement and hypertension were more prevalent in the placebo group. All other baseline patient characteristics were similar between groups. Overall POAF developed in 13.8% of the patients. There was no difference in the incidence of POAF between the NAC vs placebo groups (11.7% vs 15.8%, respectively; P = 0.34). Postoperative hospital stay, morbidity, and mortality were similar in both groups.
Prophylactic high-dose oral-NAC begun 2 days before open heart surgery and continued for 5 days, and had no significant effect on the incidence of POAF, in-hospital stay, and postoperative morbidity or mortality.