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Open Access Highly Accessed Research article

Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery: a meta-analysis of published randomized controlled trials

Xue-Hui Liu13, Chun-Yan Xu2 and Guang-Hui Fan1*

Author Affiliations

1 Department of Cardiology, Wuhan General Hospital of Guangzhou Military Command, 627 Wuluo Road, Wuhan, China

2 Department of Endocrinology, Wuhan General Hospital of Guangzhou Military Command, 627 Wuluo Road, Wuhan, China

3 Hubei University of Chinese Medicine, 1 Tanhualin Road, Wuhan, China

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BMC Cardiovascular Disorders 2014, 14:52  doi:10.1186/1471-2261-14-52

Published: 16 April 2014



Atrial fibrillation is a common complication after cardiac surgery. The aim of this study is to evaluate whether N-acetylcysteine (NAC) could prevent postoperative atrial fibrillation (POAF).


PubMed, Embase and Cochrane Center Register of Controlled Trials were searched from the date of their inception to 1 July 2013 for relevant randomized controlled trials (RCTs), in which NAC was compared with controls for adult patients undergoing cardiac surgery. Outcome measures comprised the incidence of POAF, all-cause mortality, length of intensive care unit (ICU) stay, hospital length of stay, and the incidence of cerebrovascular events. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity.


We retrieved ten studies enrolling a total of 1026 patients. Prophylactic NAC reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to 0.77; P < 0.001) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93; P = 0.03) compared with controls, but failed to reduce the stay in ICU and overall stay in hospital. No difference in the incidence of cerebrovascular events was observed.


Prophylactic use of NAC could reduce the incidence of POAF and all-cause mortality in adult patients undergoing cardiac surgery. However, larger RCTs evaluating these and other postoperative complication endpoints are needed.

N-acetylcysteine; Postoperative atrial fibrillation; Cardiac surgery; Meta-analysis