Author's response to reviews Title:Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery: a meta-analysis of published randomized controlled trials

BACKGROUND: Atrial fibrillation is the most common complication after cardiac surgery. The aim of this study is to evaluate the effect of N-acetylcysteine on the prevention of postoperative atrial fibrillation (POAF). METHODS: PubMed, Embase and Cochrane Center Register of Controlled Trials were searched from the date of their inception to 1 July 2013 for relevant studies. Eligible studies were of randomized controlled trials, reporting use N-acetylcysteine in the prevention of POAF. RESULTS: Ten randomized controlled trials were included in the present meta-analysis. Prophylactic N-acetylcysteine effectively reduced the incidence of POAF (OR 0.56; 95% CI 0.40 to 0.77; P=0.0005) and all-cause mortality (OR 0.40; 95% CI 0.17 to 0.93; P=0.03), while it failed to show significant beneficial effects on intensive care unit and hospital length of stay and cerebrovascular accident. CONCLUSIONS: This meta-analysis supports the prophylactic use of N-acetylcysteine to reduce the incidence of POAF and all-cause mortality. However, adequately powered randomized controlled trials evaluating these and other postoperative complications with or without routine prophylaxis are needed.