Comparison of Prophylactic Use of Intravenous N Acetylcysteine v/s Amiodarone in Preventing Post Operative Artrial Fibrillation after Coronary Artery Bypass Graft
DOI:
https://doi.org/10.61581/MJSP.VOL01/01/03Keywords:
Amiodarone, N-acetylcysteine, atrial fibrillation, coronary artery bypass graft, MortalityAbstract
Objective: compare the effectiveness of intravenous N-acetylcysteine and amiodarone in prevention of pos operative atrial fibrillation.
Methodology: Randomized control trial was conducted at cardiac surgery department of Choudhary Pervaiz Elahi Institute of Cardiology, Multan from December 2017 to December 2018 in one year duration. Study was conducted on 130 patients. Patients were divided into two equal groups by lottery method. Study was started after permission from academic affairs committee written informed consent from the patients. Non probability consecutive sampling was used Study variables are age, gender, duration of ICU stay and mortality. An outcome variable was post operative atrial fibrillation. Data was computed on software SPSS version 23 and analyzed for all possible variables. P value ?0.05 was taken as significant.
Results: POAF of amiodarone and NAC group was noted as 26.2% and 13.8%, respectively. The difference was statistically insignificant (0.079). Mortality of amiodarone and NAC groups was occurred as 7.7% and 4.6%, respectively. The difference was statistically insignificant (0.465).
Conclusion: intravenous N-acetylcysteine is more effective in prevention of post operative atrial fibrillation as compared intravenous amiodarone but post operative stay is prolonged in patients of NAC.
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1. Polymeropoulos E, Bagos P, Papadimitriou M, Rizos I, Patsouris E, Τoumpoulis I. Vitamin C for the Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis. Adv Pharm Bull. 2016;6(2):243-50.
2. Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther. 2015;154:13-20.
3. Alawami M, Chatfield A, Ghashi R, Walker L. Atrial fibrillation after cardiac surgery: Prevention and management: The Australasian experience. J Saudi Heart Assoc. 2018;30(1):40-46.
4. Gholipour Baradari A, Emami Zeydi A, Ghafari R. A double-blind randomized clinical trial comparing different doses of magnesium in cardioplegic solution for prevention of atrial fibrillation after coronary artery bypass graft surgery. Cardiovasc Ther. 2016; 34(4): 276–82.
5. Hu YF, Chen YJ, Lin YJ. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015; 12(4): 230–43.
6. Song JW, Shim JK, Soh S. Double-blinded, randomized controlled trial of N-acetylcysteine for prevention of acute kidney injury in high risk patients undergoing off-pump coronary artery bypass. Nephrology (Carlton). 2015; 20(2): 96–102.
7. Erdil N, Eroglu T, Akca B. The effects of N-acetylcysteine on pulmonary functions in patients undergoing on-pump coronary artery surgery: a double blind placebo controlled study. Eur Rev Med Pharmacol Sci. 2016; 20(1):180–87.
8. Arfsten D, Johnson E, Thitoff A, Jung A, Wilfong E, Lohrke S, et al. Impact of 30-day oral dosing with N-acetyl-L-cysteine on Sprague-Dawley rat physiology. Int J Toxicol. 2004;23:239–47. Kerstein J, Soodan A, Qamar M. Giving IV and oral amiodarone perioperatively for the prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery: the GAP study. Chest 2004;126:716–24.
9. Musa AF, Dillon J, Md Taib ME. Hypotheses, rationale, design, and methods for evaluation of a randomized controlled trial using Tocotrienol, an isomer of Vitamin E derived from palm oil, on the prevention of atrial fibrillation after coronary artery bypass grafting surgery F1000Research 2018;7:p215.
10. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108:3006-10.
11. Onk OA, Erkut B. Is the Preoperative Administration of Amiodarone or Metoprolol More Effective in Reducing Atrial Fibrillation: After Coronary Bypass Surgery?. Medicine (Baltimore). 2015;94(41):e1576.
12. Guarnieri T, Nolan S, Gottlieb SO, Dudek A, Lowry DR. Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the Amiodarone Reduction in Coronary Heart (ARCH) trial. J Am Coll Cardiol. 1999;34(2):343–347.
13. 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. BMC Cardiovasc Disord. 2014;14:p52.
14. Ozaydin M, Peker O, Erdogan D, Kapan S, Turker Y, Varol E. N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study. Eur Heart J. 2008;29(5):625-31.
15. Gu WJ. N-acetylcysteine supplementation for the prevention of atrial fibrillation after cardiac surgery. A meta analysis of eight randomized control trials. Cardiovas Disorder. 2012;12:p10.
16. White CM, Caron MF, Kalus JS. Intravenous plus oral amiodarone, atrial septal pacing, or both strategies to prevent post-cardiothoracic surgery atrial fibrillation: the Atrial Fibrillation Suppression Trial II (AFIST II). Circulation. 2003;108(Suppl 1):II200–206.
17. Mitchell LB, Exner DV, Wyse DG, et al. Prophylactic Oral Amiodarone for the Prevention of Arrhythmias that Begin Early After Revascularization, Valve Replacement, or Repair: PAPABEAR: a randomized controlled trial. JAMA. 2005;294(24):3093–3100.
18. Wang G, Bainbridge D, Martin J, Cheng D. N-acetylcysteine in cardiac surgery: do the benefits outweigh the risks? A meta-analytic reappraisal. J Cardiothorac Vasc Anesth. 2011;25(2):268–275.
19. Alqahtani AA. Atrial fibrillation post cardiac surgery trends toward management. Heart Views. 2010;11(2):57-63.
20. Daoud EG, Strickberger SA, Man KC, Goyal R, Deeb GM, Bolling SF, et al. Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med. 1997;337:1785–91.
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Copyright (c) 2020 Muhammad Ramzan, Muhammad Kashif Javed, Jehan Zab, Muhammad Shoaib Abid, Hamza Ghafor, Abu Bakar Ali Saad
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