Abstract
BackgroundAtrial fibrillation is the most common type of arrhythmia after cardiac surgery. An increasing body of evidence demonstrates that oxidative stress plays a pivotal role in the pathophysiology of atrial fibrillation. N-acetylcysteine (NAC) is a free radical scavenger, and may attenuate this pathophysiologic response and reduce the incidence of postoperative AF (POAF). However, it is unclear whether NAC could effectively prevent POAF. Therefore, this meta-analysis aims to assess the efficacy of NAC supplementation on the prevention of POAF.MethodsMedline and Embase were systematically reviewed for studies published up to November 2011, in which NAC was compared with controls for adult patients undergoing cardiac surgery. Outcome measures comprised the incidence of POAF and hospital length of stay (LOS). The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity.ResultsEight randomized trials incorporating 578 patients provided the best evidence and were included in this meta-analysis. NAC supplementation significantly reduced the incidence of POAF (OR 0.62, 95% CI 0.41 to 0.93; P = 0.021) compared with controls, but had no effect on LOS (WMD -0.07, 95% CI -0.42 to 0.28; P = 0.703).ConclusionsThe prophylactic NAC supplementation may effectively reduce the incidence of POAF. However, the overall quality of current studies is poor and further research should focus on adequately powered randomized controlled trials with POAF incidence as a primary outcome measure.
Highlights
Atrial fibrillation is the most common type of arrhythmia after cardiac surgery
In the past few years, a growing body of evidence suggests that oxidative stress has been found to play a pivotal role in the pathophysiology of postoperative AF (POAF) [10]
Identification of eligible studies Eighty-three reports were identified by the initial literature retrieval, with limiting to human subjects and randomized controlled trials
Summary
An increasing body of evidence demonstrates that oxidative stress plays a pivotal role in the pathophysiology of atrial fibrillation. Nacetylcysteine (NAC) is a free radical scavenger, and may attenuate this pathophysiologic response and reduce the incidence of postoperative AF (POAF). It is unclear whether NAC could effectively prevent POAF. Postoperative atrial fibrillation (POAF) is the most frequent arrhythmia encountered following cardiac surgery, affecting approximately 25-40% of patients [1,2,3]. In the past few years, a growing body of evidence suggests that oxidative stress has been found to play a pivotal role in the pathophysiology of POAF [10]. Oxidative stress may be one of a possible pathogenesis of POAF [11]
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