European Heart Journal Advance Access originally published online on October 2, 2008
European Heart Journal 2008 29(22):2823; doi:10.1093/eurheartj/ehn446
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N-acetylcysteine for the prevention of atrial fibrillation: beyond its antioxidant effect: reply
Department of Cardiology
Suleyman Demirel University
School of Medicine
Isparta
Turkey
Kurtulus Mah
122. cad. Hatice Halici apt. no. 126
32040 Isparta
Turkey
Tel: +90 532 413 9528
Fax: +90 246 232 6280
Email: mehmetozaydin{at}hotmail.com
Department of Cardiovascular Surgery
Suleyman Demirel University
School of Medicine
Isparta
Turkey
Department of Cardiology
Suleyman Demirel University
School of Medicine
Isparta
Turkey
Department of Cardiology
Gulkent State Hospital
Isparta
Turkey
Department of Cardiology
Suleyman Demirel University
School of Medicine
Isparta
Turkey
Department of Cardiology
Suleyman Demirel University
School of Medicine
Isparta
Turkey
We would like to thank Barrios et al. for their kind interest on our manuscript.1 As they addressed in their letter, we considered that oxidative stress plays a main role in the development of postoperative atrial fibrillation (AF).
As the authors stated, recent trials have suggested that rennin–angiotensin system (RAS) may play a role in the pathophysiology of AF and that inhibition of this system may protect against AF. Meta-analyses not involving cardiac surgery patients have shown that chronic therapy with RAS blockers is associated with a reduction of new-onset AF. With respect to the postoperative AF, conflicting results have been obtained: although Mathew et al.2 have found that RAS blockers are associated with low incidence of postoperative AF, however, other two studies were unable to confirm this association.3,4
The authors stated that N-acetylecysteine (NAC) may have a potentiative synergistic effect on RAS blockade. We totally agree with them. This mechanism is shortly discussed on page 630. We appreciate their detailed contribution.
It can be speculated that addition of a sulphhydryl donor such as NAC to the RAS blockers routinely in the future trials may potentiate their effects on postoperative AF.
References
- 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) 29:625–631.
[Abstract/Free Full Text] - Mathew JP, Fontes ML, Tudor IC, Barrios, et al, Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. A multicenter risk index for atrial fibrillation after cardiac surgery. J Am Med Assoc (2004) 291:1720–1729.
[Abstract/Free Full Text] - White CM, Kluger J, Lertsburapa K, Faheem O, Coleman CI. Effect of preoperative angiotensin converting enzyme inhibitor or angiotensin receptor blocker use on the frequency of atrial fibrillation after cardiac surgery: a cohort study from the atrial fibrillation suppression trials II and III. Eur J Cardiothorac Surg (2007) 31:818–821.
- Coleman CI, Makanji S, Kluger J, White CM. Effect of angiotensin-converting enzyme
nhibitors or angiotensin receptor blockers on the frequency of post cardiothoracic surgery atrial fibrillation. Ann Pharmacother (2007) 41:433–437.[Abstract/Free Full Text]
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