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

Year 2019, Volume: 36 Issue: 3, 81 - 85, 10.02.2020

Elif Coşkun Sungur , Levent Altınay , Mustafa Buyukates

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. 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. 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. 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. 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. Goettea A, Lendeckel U. Nonchannel drug targets in atrial fibrillation. Pharmacol Ther 2004, 102:17-36.
• 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Krzych LJ, Szurlej D, Bochenek A. Rationale for propofol use in cardiac surgery. J Cardiothorac Vasc Anesth. 2009; 23(6): 878–885.
• 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. 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.