Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery: A Randomized Controlled Trial

• Published in: JAMA : the journal of the American Medical Association 2007-04, Vol.297 (14), p.1562-1567
• Main Authors: Halonen, Jari, Halonen, Pirjo, Järvinen, Otso, Taskinen, Panu, Auvinen, Tommi, Tarkka, Matti, Hippeläinen, Mikko, Juvonen, Tatu, Hartikainen, Juha, Hakala, Tapio
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Aortic Valve; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiac Surgical Procedures - adverse effects; Cardiology. Vascular system; Cardiopulmonary Bypass; Clinical outcomes; Clinical trials; Coronary Artery Bypass; Cortisone; Double-Blind Method; Female; General aspects; Heart; Heart surgery; Heart Valve Prosthesis Implantation; Humans; Hydrocortisone - administration & dosage; Hydrocortisone - therapeutic use; Injections, Intravenous; Kaplan-Meier Estimate; Male; Medical sciences; Medical treatment; Meta-Analysis as Topic; Middle Aged; Prevention and actions; Proportional Hazards Models; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.297.14.1562

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