The effect of intravenous N-acetyl cysteine on the incidence of postoperative atrial fibrillation in coronary artery bypass graft surgery patients

Abstract

Atrial fibrillation is the most frequent arrhythmia after open heart surgery. The aim of this study was to determine the effect of intravenous (IV) N-acetyl cys-teine (NAC) administration in the early postoperative period of coronary ar-tery bypass (CABG) surgery on the incidence of postoperative atrial fibrillation (POAF). A total of 60 patients who had undergone isolated CABG surgery be-tween June 2014 – July 2015 in our clinic included in this retrospective study. The patients divided into two groups: Group 1 (n=30) included the patients who had been administered standard saline solution infusion and Group 2 (n=30) included the patients who had been administered IV NAC (10mg/kg) infusion while they were under mechanical ventilation support. All patients were ad-ministrated oral 600 mg NAC once a day for 5 days after weaning from me-chanical ventilation support. The ECG’s were evaluated for POAF by the same cardiovascular surgeon who was blinded for patient groups. POAF was seen in 12 (40%) patients in Group 1 and 4 (13%) patients in Group 2. The POAF incidence was significantly higher in Group 1 (p=0.020). We think that admin-istration IV NAC is an effective way to prevent the POAF after CABG surgery.

Keywords

• Postoperative atrial fibrillation,coronary artery bypass surgery,n-acetyl cysteine

References

1. 1. Soleimani A, Hasanzadeh Kiabi F, Emami Zeydi A, et al. Can white blood cell count be used as a predictor of atrial fibrillation following cardiac surgery? A short literature review. Anadolu Kardiyol Derg. 2014; 14(2): 216–217.
2. 2. Gholipour Baradari A, Emami Zeydi A, Ghafari R, et al. A dou¬ble-blind randomized clinical trial comparing different doses of magnesium in cardioplegic solution for prevention of atrial fibril¬lation after coronary artery bypass graft surgery. Cardiovasc Ther. 2016; 34(4): 276–282.
3. 3. Kazemi B, Akbarzadeh F, Safaei N, et al.: Prophylactic high-dose Oral-N-Acetylcysteine does not prevent atrial fibrillation after heart surgery: a prospective double blind placebocontrolled randomized clinical trial. Pacing Clin Electrophysiol 2013, 36:1211–1219.
4. 4. Arfsten D, Johnson E, Thitoff A, et al. Impact of 30-day oral dosing with N-acetyl-Lcysteine on Sprague-Dawley rat physiology. Int J Toxicol 2004;23:239—47.
5. 5. Goettea A, Lendeckel U. Nonchannel drug targets in atrial fibrillation. Pharmacol Ther 2004, 102:17-36.
6. 6. Eslami M, Badkoubeh RS, Mousavi M, et al. Oral ascorbic acid in combination with betablockers is more effective than beta-blockers alone in the prevention of atrial fibrillation after coronary artery baypas grafting. Tex Heart Inst J 2007;34:268—74.
7. 7. Lertsburapa K, White CM, Kluger J, et al. Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery. J Thorac Cardiovasc Surg 2008;135:405—11.
8. 8. Liu XH, Xu CY, Fan GH. Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery:a meta-analysis of published randomized controlled trials. BMS Cardiovascular Disorders 2014:14(52).

9. 9. Baker W.L, Anglade M.W, Baker E.L. et al. Use of N-acetylcysteine to reduce postcardiothoracic surgery complications: a meta-analysis. Eur J Cardio-Thoracic Surgery 35(2009): 521-527.
10. 10. Gu WJ, Wu ZJ, Wang PF. et al. N-acetylcysteine supplementation for the prevention of atrial fibrillation after cardiac surgery: a meta-analysis of eight randomized controlled trials. BMC Cardiovascular Disorders 2012:12(10).
11. 11. Ali-Hassan-Sayegh S, Mirhosseini S.J., Rezaeisadrabadia M, et al. Antioxidant supplementations for prevention of atrial fibrillation after cardiac surgery: an updated comprehensive systematic review and meta-analysis of 23 randomized controlled trials. Interactive CardioVascular and Thoracic Surgery 18 (2014) 646–654.
12. 12. Mathew JP, Fontes ML, Tudor IC, et al. A multicenter risk for atrial fibrillation after cardiac surgery. JAMA 2004, 291, Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group):1720-1729.
13. 13. Cairns JA, Connolly S, McMurtry S, et al. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. Can J Cardiol 2011, 27:74–90.
14. 14. Ozaydin M, Peker O, Erdogan D, et al. N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study. Eur Heart J 2008, 29:625–631.
15. 15. Soleimani A, Habibi M.R., Kiabi F.H., et al. The effect of intravenous N-acetylcysteine on prevention of atrial fibrillation after coronary artery bypass graft surgery: a double-blind, randomised, placebo-controlled trial. Kardiologia Polska 2018; 76, 1: 99–106.
16. 16. Krzych LJ, Szurlej D, Bochenek A. Rationale for propofol use in cardiac surgery. J Cardiothorac Vasc Anesth. 2009; 23(6): 878–885.
17. 17. Wijeysundera DN, Beattie WS, Rao V, et al. N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency. Can J Anaesth 2007, 54:872–881.
18. 18. Peker O, Peker T, Erdogan D, et al. Effects of intravenous N-acetylcysteine on periprocedural myocardial injury after on-pump coronary artery by-pass grafting. J Cardiovasc Surg (Torino)2008, 49:527-531.