| Title | Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. | | Author(s) | Halonen J, Halonen P, Järvinen O, Taskinen P, Auvinen T, Tarkka M, Hippeläinen M, Juvonen T, Hartikainen J, Hakala T | | Institution | Departments of Surgery and Internal Medicine, Kuopio University Hospital, and Computing Center of Kuopio University, Kuopio; | | Source | JAMA 2007 Apr 11; 297(14):1562-7. | | MeSH | Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents
Aortic Valve
Atrial Fibrillation
Cardiac Surgical Procedures
Cardiopulmonary Bypass
Coronary Artery Bypass
Double-Blind Method
Female
Heart Valve Prosthesis Implantation
Humans
Hydrocortisone
Injections, Intravenous
Kaplan-Meiers Estimate
Male
Meta-Analysis
Middle Aged
Proportional Hazards Models
Prospective Studies
| | Abstract | 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. | | Language | eng | | Pub Type(s) | Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
| | PubMed ID | 17426275 |
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