JAMA
Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery: A Randomized Controlled Trial
Jari Halonen, MD; Pirjo Halonen, PhD; Otso Järvinen, MD, PhD; Panu Taskinen, MD; Tommi Auvinen, MD; Matti Tarkka, MD, PhD; Mikko Hippeläinen, MD, PhD; Tatu Juvonen, MD, PhD; Juha Hartikainen, MD, PhD; Tapio Hakala, MD, PhD
Context:
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.
Objective:
To test whether intravenous corticosteroid administration after cardiac surgery prevents AF after cardiac surgery.
Design, Setting, and Patients:
A 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.
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%]; 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.
Conclusion:
Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery.
Trial Registration:
clinicaltrials.gov Identifier: NCT00442494.
jama. 2007;297(14):1562-1567.