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European Heart Journal Advance Access originally published online on February 8, 2008
European Heart Journal 2008 29(5):625-631; doi:10.1093/eurheartj/ehn011
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study

Mehmet Ozaydin1,*, Oktay Peker2, Dogan Erdogan1, Sahin Kapan2, Yasin Turker3, Ercan Varol4, Fehmi Ozguner5, Abdullah Dogan1 and Erdogan Ibrisim2

1 Department of Cardiology, Suleyman Demirel University, School of Medicine, 32040 Isparta, Turkey
2 Department of Cardiovascular Surgery, Suleyman Demirel University, School of Medicine, Isparta, Turkey
3 Department of Cardiology, Gulkent State Hospital, Isparta, Turkey
4 Department of Cardiology, Isparta State Hospital, Isparta, Turkey
5 Department of Physiology, Suleyman Demirel University, School of Medicine, Isparta, Turkey

Received 26 July 2007; revised 16 December 2007; accepted 8 January 2008; online publish-ahead-of-print 8 February 2008.

* Corresponding author. Tel: +90 532 413 9528, Fax: +90 246 232 6280, E-mail: mehmetozaydin{at}hotmail.com

Aims: Oxidative stress has recently been implicated in the pathophysiology of atrial fibrillation (AF). The aim of the present study was to evaluate the effects of antioxidant agent N-acetylcysteine (NAC) on postoperative AF.

Methods and results: The population of this prospective, randomized, double-blind, placebo-controlled study consisted of 115 patients undergoing coronary artery bypass and/or valve surgery. All the patients were treated with standard medical therapy and were randomized to NAC group (n = 58) or placebo (saline, n = 57). An AF episode >5 min during hospitalization was accepted as endpoint. During follow-up period, 15 patients (15/115, 13%) had AF. The rate of AF was lower in NAC group compared with placebo group (three patients in NAC group [5.2%] and 12 patients in placebo group [21.1%] had postoperative AF; odds ratio [OR] 0.20; 95% confidence interval [CI] 0.05 to 0.77; P = 0.019). In the multivariable logistic regression analysis, independent predictors of postoperative AF were left atrial diameter (OR, 1.18; 95% CI, 1.06–1.31; P = 0.002) and the use of NAC (OR, 0.20; 95% CI, 0.04–0.91; P = 0.038).

Conclusion: The result of this study indicates that NAC treatment decreases the incidence of postoperative AF.

Key Words: N-acetylcysteine • Cardiac surgery • Atrial fibrillation


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