Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: In their randomized controlled trial of corticosteroids for prevention of atrial fibrillation (AF) after cardiac surgery, Dr Halonen and colleagues1 found that intravenous hydrocortisone therapy reduced the incidence of postoperative AF. In the study protocol, all patients were administered oral metoprolol according to their heart rate during the postoperative 84 hours. β-Blockers such as metoprolol may prevent postoperative AF, with a meta-analysis suggesting that β-blockers could reduce postoperative AF as much as sotalol or amiodarone.2 Therefore, the metoprolol dose may have been an important confounder. The authors did not indicate whether there were any differences in overall oral metoprolol dose between the corticosteroid and the placebo groups in their study.
Oh J, Chung J, Kang S. Use of Corticosteroids to Prevent Atrial Fibrillation After Cardiac Surgery. JAMA. 2007;298(3):283-284. doi:10.1001/jama.298.3.283-a