Oxidative status, inflammation, and postoperative atrial fibrillation with metoprolol vs carvedilol or carvedilol plus N-acetyl cysteine treatment

Clin Cardiol. 2014 May;37(5):300-6. doi: 10.1002/clc.22249. Epub 2014 Jan 29.


Background: Atrial fibrillation is associated with inflammation and oxidative stress.

Hypothesis: Carvedilol and N-acetyl cysteine (NAC) combination decreases inflammation, oxidative stress, and postoperative atrial fibrillation (POAF) rates more than metoprolol or carvedilol.

Methods: Preoperative and postoperative total oxidative stress (TOS), total antioxidant capacity (TAC), and white blood cells (WBC) were measured in metoprolol, carvedilol, or carvedilol plus NAC groups, and association with POAF was evaluated.

Results: Preoperative TAC, TOS, and WBC levels were similar among the groups. Postoperative TAC levels were lower in the metoprolol group compared with the carvedilol group (1.0 vs 1.4) or the carvedilol plus NAC group (1.0 vs 1.9) and were also lower in the carvedilol group compared with the carvedilol plus NAC group (all P < 0.0001). Postoperative TOS levels were higher in the metoprolol group as compared with the carvedilol (29.6 vs 24.2; P < 0.0001) or the carvedilol plus NAC groups (P < 0.0001), and were also higher in the carvedilol group as compared with the carvedilol plus NAC group (24.2 vs 19.3; P < 0.0001). Postoperative WBC counts were lower in the carvedilol plus NAC group compared with the metoprolol group (12.9 vs 14.8; P = 0.004), were similar between the carvedilol and the metoprolol groups (13 vs 14.8) and between the carvedilol plus NAC group and the carvedilol group (both P > 0.05). Postoperative TAC, TOS, and WBC were associated with POAF.

Conclusions: Carvedilol plus NAC reduced oxidative stress and inflammation compared with metoprolol and decreased oxidative stress compared with carvedilol. Postoperative TAC, TOS, and WBC were associated with POAF.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acetylcysteine / adverse effects
  • Acetylcysteine / therapeutic use*
  • Aged
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / physiopathology
  • Carbazoles / adverse effects
  • Carbazoles / therapeutic use*
  • Cardiac Surgical Procedures
  • Carvedilol
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Free Radical Scavengers / adverse effects
  • Free Radical Scavengers / therapeutic use*
  • Humans
  • Inflammation / drug therapy*
  • Leukocyte Count
  • Male
  • Metoprolol / administration & dosage
  • Metoprolol / therapeutic use*
  • Middle Aged
  • Oxidative Stress / drug effects*
  • Postoperative Period
  • Propanolamines / adverse effects
  • Propanolamines / therapeutic use*
  • Prospective Studies
  • Treatment Outcome


  • Antihypertensive Agents
  • Carbazoles
  • Free Radical Scavengers
  • Propanolamines
  • Carvedilol
  • Metoprolol
  • Acetylcysteine