European Heart Journal Advance Access originally published online on April 25, 2008
European Heart Journal 2008 29(12):1591; doi:10.1093/eurheartj/ehn178
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N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study
Department of Cardiology
School of Medicine
Marmara University
Istanbul
Turkey
Tel: +90 212 560 6793
Fax: +90 216 327 6035
Email: okanerdogan{at}yahoo.com
I read with great interest the article by Ozaydin et al.1 recently published in European Heart Journal. They briefly compared N-acetylcysteine (NAC) therapy for prevention of postoperative atrial fibrillation (AF) by a randomized, placebo-controlled study and showed that NAC significantly decreased the incidence of postoperative AF. Only three patients in the NAC group, as opposed to 12 patients in the control group, developed AF (P = 0.01). Table 3 shows the follow-up findings and the median duration as well as the range of AF episodes of both groups. The range of AF duration in the NAC group was between 10 and 96 min, whereas it was between 1 and 240 min for control patients. Although the authors accepted an AF episode lasting longer than 5 min as endpoint, it seems that patients with AF episodes <5 min duration were also included in the control group, according to Table 3. If it is so, we may then conclude that the number of control patients with AF episodes was overestimated, indicating a selection bias because some of them had AF episodes <5 min duration. However, this is not the case in NAC patients because all of them had AF episodes of >5 min duration (range, 10–96 min). This means that some of the patients with AF duration <5 min were included in the control group to increase the number of patients with AF and cause statistical significance. Additionally, the technique by which the patients were observed or monitored in intensive care unit was not clearly described. Whether the rhythm was continuously recorded by telemetry and Holter as well as rhythm strips were retrospectively evaluated at a later date by blinded investigators should be clearly described within the text, because short episodes of AF with 1 or 2 min even >5 min duration might certainly be overlooked just by watching the monitor and taking ECGs.
Reference
- Ozaydin M, Peker O, Erdogan D, Kapan S, Turker Y, Varol E, Ozguner F, Dogan A, Ibrisim E. N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study. Eur Heart J (2008) 29:625–331.
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