KARDİYAK CERRAHİDE POSTOPERATİF ATRİYAL FİBRİLASYON GELİŞİMİNİN ÖNLENMESİNDE N-ASETİLSİSTEİN'İN ETKİNLİĞİ: SİSTEMATİK DERLEME VE META-ANALİZ

Giriş: Atriyal fibrilasyon kalp cerrahisi sonrasında en sık gelişen ve önemli morbidite, mortalite artışına yol açan aritmidir.Bu incelemede, atriyal fibrilasyon gelişimini engellemek amacı ile preoperatif dönemde uygulanan N-asetilsisteinin etkinliğinianaliz etmeyi amaçladık.Yöntem: Literatür taraması tarih sınırlaması olmadan dört elektronik veritabanında (Pubmed, Web of Science, Science Directve Ovid) yapıldı. İlacın veriliş yolu ya da dozu sınırlaması olmaksızın preoperatif dönemde N-asetilsistein uygulanan araştırmalardahil edildi. Araştırmaların bulguları heterojenite varlığına göre random ya da sabit etki modeli ile değerlendirildi. İstatistikseldeğerlendirme Open Meta Analyst programı kullanılarak uygulandı. Bulgular: Veritabanı taramasından sonra toplam 11248 makaleye ulaşıldı. Makale başlıklar ve özetler gözden geçirildiktensonra 418 hastadan oluşan ve dahil etme kriterlerine uyan 6 makale meta-analize dahil edildi. Yapılan analizde 50mg intravenözN-asetilsisteinin postoperatif atriyal fibrilasyonu önlemede etkili olduğu (OR=0,214 %95 güven aralığı: 0,068-0,670 ve p=0,008)ancak 100mg intravenöz N-asetilsisteinin etkili olmadığı (OR=0,642 %95 güven aralığı:0,371-1,110 ve p=0,113) gözlendi. OralN-asetilsisteinin etkinliğinin değerlendirilmesi için yeterli araştırmaya ulaşılamadı. Analize dahil edilen araştırmalar heterojendeğildi (I2

EFFICACY OF N-ACETYLCYSTEIN IN PREVENTION OF POSTOPERATIVE ATRIAL FIBRILLATION DEVELOPMENT IN CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Atrial fibrillation is the most common and leading important morbidity and mortality arythmia after cardiacsurgery. In this review, we aimed to analyse the effectiveness of N-acetylcysteine used in preoperative period for prevention ofatrial fibrillation development. Method: Literature search was performed in four electronic database (Pubmed, Web of Science, Science Direct and Ovid)without date limitation. Trials, in which N-acetylcysteine was applied in preoperative period without application route or dose,were included. The results of studies were evaluated by random or fixed effect model according to the heterogeneity. Statisticalanalysis was performed by using Open Meta Analyst software. Results: Through the data base search, we could reach 11248 articles. After the overview of titles and abstracts, we includedthe meta-analysis of 6 articles which contain 418 patients and abide with the rules of inclusion criteria. In analysis, it wasobserved that 50 mg intravenous N-acetylcysteine was effective (OR: 0.214 95% CI: 0.068-0.670 ve p=0.008) in prevention ofpostoperative atrial fibrillation but 100 mg intravenous N-acetylcysteine was not effective (OR: 0.642 95% CI; 0.371-1.110 vep=0.113). For evalaution of oral N-acetylcysteine effeciency, we could not find adequate trials. Studies included the analysis werenot heterogenous (I2<%25).Conclusion: We concluded that 50 mg intravenous N-acetylcysteine was effective for prevention of postoperative atrial fibrillationdevelopment. On the other hand, there is a need for further and standardized trials to evaluate oral N-acetylcysteine.

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