What does this research mean for the field?

Carvedilol plus N-acetyl cysteine significantly reduces the incidence of post-operative atrial fibrillation and duration of hospitalization compared with metoprolol or carvedilol alone in cardiac surgery patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the efficacy of metoprolol, carvedilol, and carvedilol combined with N-acetyl cysteine (NAC) in preventing post-operative atrial fibrillation (POAF) in cardiac surgery patients.

August 19, 2026European Heart JournalOpen Access

Metoprolol vs. carvedilol or carvedilol plus N-acetyl cysteine on post-operative atrial fibrillation: a randomized, double-blind, placebo-controlled study

Q: What are the key findings of this study?

Carvedilol plus N-acetyl cysteine reduced the incidence of post-operative atrial fibrillation compared with metoprolol (P<0.0001) and carvedilol alone (P=0.03) in cardiac surgery patients.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Post-operative atrial fibrillation (n=311). Intervention: Carvedilol plus N-acetyl cysteine vs. Metoprolol or carvedilol alone. Primary outcome: Incidence of post-operative atrial fibrillation (POAF) (p=<0.0001).

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Key result

Carvedilol plus N-acetyl cysteine reduces POAF versus metoprolol or carvedilol alone after cardiac surgery.

P<0.0001
n=311

Why the study?

Carvedilol and N-acetyl cysteine possess antioxidant and anti-inflammatory properties, prompting evaluation of metoprolol, carvedilol, and carvedilol plus N-acetyl cysteine for preventing post-operative atrial fibrillation.

Does carvedilol alone or carvedilol plus N-acetyl cysteine reduce the incidence of post-operative atrial fibrillation in patients undergoing cardiac surgery compared to metoprolol?

Population

311 patients undergoing cardiac surgery

Comparison

Metoprolol vs carvedilol vs carvedilol plus NAC

Design

Randomized, double-blind, placebo-controlled study

Authors

MÖMehmet ÖzaydınElectrophysiology HYHabil YücelSüleyman Demirel University SAS. AkçayAhi Evran University

Discussion

Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

MI Mohammadreza IranianPhysician, Rajaie Cardiovascular Medical and Research Center

“Results of our study showed that N-acetylcysteine cannot have a significant effect on decreasing the incidence of AF following CABG surgery. However, it should be noted that considering the P value is close to.05, by changing the number of studied samples or using a higher dose of N-acetylcysteine or using intravenous injection, a significant relationship between the N-acetylcysteine administration and decrease in the incidence of AF following CABG may be observed.”

Iran University of Medical ScienceNews Coverage

Implication

Carvedilol plus NAC may reduce POAF after cardiac surgery; extends beta-blocker trials with antioxidant adjunct.

Key Points

To evaluate the efficacy of metoprolol, carvedilol, and carvedilol combined with N-acetyl cysteine (NAC) in preventing post-operative atrial fibrillation (POAF) in cardiac surgery patients.
Randomized, double-blind, placebo-controlled trial in patients undergoing cardiac surgery (n = 311).
Participants were allocated to receive metoprolol, carvedilol, or carvedilol plus N-acetyl cysteine (NAC).
The incidence of POAF was significantly lower in the carvedilol plus NAC group compared with the metoprolol group (P < 0.0001) and the carvedilol group (P = 0.03).
Carvedilol alone showed borderline lower POAF rates compared with metoprolol (P = 0.06).
Duration of hospitalization was significantly shorter in the carvedilol plus NAC group compared with the metoprolol group (P = 0.004).

Study Design

Type

RCT (n=311)

Blinding

Double-blind

Randomization

randomized

Structured PICO

Does carvedilol alone or carvedilol plus N-acetyl cysteine reduce the incidence of post-operative atrial fibrillation in patients undergoing cardiac surgery compared to metoprolol?

Population

311 patients undergoing cardiac surgery randomized to metoprolol, carvedilol, or carvedilol plus N-acetyl cysteine.

Intervention

Carvedilol alone or carvedilol plus N-acetyl cysteine (NAC)

Comparator

Metoprolol

Outcome

Incidence of post-operative atrial fibrillation (POAF)

Main Result

p-value: p=<0.0001

The combination of carvedilol and N-acetyl cysteine is more effective than metoprolol or carvedilol alone in preventing post-operative atrial fibrillation and reducing hospital stay after cardiac surgery.

Cite This Study

Özaydın et al. (2012) conducted an RCT in Post-operative atrial fibrillation (n=311). Carvedilol plus N-acetyl cysteine vs. Metoprolol or carvedilol alone was evaluated on Incidence of post-operative atrial fibrillation (POAF) (p=<0.0001). Carvedilol plus N-acetyl cysteine reduced the incidence of post-operative atrial fibrillation compared with metoprolol (P<0.0001) and carvedilol alone (P=0.03) in cardiac surgery patients.

synapsesocial.com/papers/6a854347fe78b5834bb8152c https://doi.org/10.1093/eurheartj/ehs423

Topics

Persistent AF management Atrial fibrillation Anticoagulation in AF AF ablation outcomes

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Metoprolol vs. carvedilol or carvedilol plus N-acetyl cysteine on post-operative atrial fibrillation: a randomized, double-blind, placebo-controlled study

Discussion

Member takes

Key expert perspectives

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Metoprolol vs. carvedilol or carvedilol plus N-acetyl cysteine on post-operative atrial fibrillation: a randomized, double-blind, placebo-controlled study

Discussion

Member takes

Key expert perspectives

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider