Tuesday November 11, 2008
Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery

Atrial fibrillation (AF) is the most common arrhythmia to occur after cardiac surgery. An exaggerated inflammatory response has been proposed to be one etiological factor. Study was done to test whether intravenous corticosteroid administration after cardiac surgery prevents AF after cardiac surgery. A double-blind, randomized multicenter trial in 3 university hospitals in Finland of 241 consecutive patients without prior AF or flutter and scheduled to undergo first on-pump coronary artery bypass graft (CABG) surgery, aortic valve replacement, or combined CABG surgery and aortic valve replacement.

Intervention: Patients were randomized to receive either 100-mg hydrocortisone or matching placebo as follows: the first dose in the evening of the operative day, then 1 dose every 8 hours during the next 3 days. In addition, all patients received oral metoprolol (50-150 mg/d) titrated to heart rate.

Main Outcome Measure: Occurrence of AF during the first 84 hours after cardiac surgery.

Results

• The incidence of postoperative AF was significantly lower in the hydrocortisone group (36/120 [30%]) than in the placebo group (58/121 [48%]
• Compared with placebo, patients receiving hydrocortisone did not have higher rates of superficial or deep wound infections, or other major complications.

Conclusion: Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery.

Reference: Click to get abstract/article

Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery JAMA. 2007;297:1562-1567.