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September 1, 2007

Reducing the Incidence of Atrial Fibrillation

Arch Surg. 2007;142(9):821. doi:10.1001/archsurg.142.9.821


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.

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