Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery

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Abstract
Research from JAMA — Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery — A Randomized Controlled Trial — ContextAtrial fibrillation (AF) is the most common arrhythmia to occur after cardiac surgery. An exaggerated inflammatory response has been proposed to be one etiological factor.ObjectiveTo test whether intravenous corticosteroid administration after cardiac surgery prevents AF after cardiac surgery.Design, Setting, and PatientsA double-blind, randomized multicenter trial (study enrollment August 2005–June 2006) 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.InterventionPatients 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 MeasureOccurrence of AF during the first 84 hours after cardiac surgery.ResultsThe incidence of postoperative AF was significantly lower in the hydrocortisone group (36/120 [30%]) than in the placebo group (58/121 [48%]; adjusted hazard ratio, 0.54; 95% confidence interval, 0.35-0.83; P = .004; number needed to treat, 5.6). Compared with placebo, patients receiving hydrocortisone did not have higher rates of superficial or deep wound infections, or other major complications.ConclusionIntravenous hydrocortisone reduced the incidence of AF after cardiac surgery.Trial Registrationclinicaltrials.gov Identifier: NCT00442494

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