Postoperative atrial fibrillation is one of the most common complications after thoracic noncardiac surgery. Despite contemporary prevention strategies, the rate of this complication can be as high as 40% in high-risk patients. Certain patient characteristics, including hypertension, obesity, smoking, male sex, and Caucasian ancestry, are known risk factors. Emerging evidence suggests that postoperative atrial fibrillation is not a transient benign phenomenon but rather an ominous postoperative complication associated with increased risk of thromboembolism, stroke, and mortality. Excessive inflammation associated with both tissue and extracellular free radical oxygen–mediated injury resulting from operative insult is thought to be an important contributing factor in postoperative atrial fibrillation pathophysiology. Anti-inflammatory strategies have been investigated for postoperative atrial fibrillation prophylaxis and demonstrated variable success.

In this issue of Anesthesiology, Amar et al. studied the effect of N-acetylcysteine, a known antioxidant and free radical scavenger, as a prophylactic measure for postoperative atrial fibrillation...

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