IV steroids reduce risk of AF following cardiac surgery

Results from a small trial have shown that IV corticosteroids given after cardiac surgery can significantly reduce the risk of developing postsurgical atrial fibrillation.In this double-blind, randomized multicentre trial Halonen and collagues randomized 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 both, 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 three days. In addition, all patients received oral metoprolol (50-150 mg/d) titrated to heart rate. The main outcome measure of the study was occurrence of AF during the first 84 hours after cardiac surgery. The researchers found that intravenous hydrocortisone reduced the relative risk of postoperative AF by 37% compared with placebo in patients undergoing CABG surgery, aortic valve replacement, or combined CABG surgery and aortic valve replacement.Compared with placebo, patients receiving hydrocortisone did not have higher rates of superficial or deep wound infections, or other major complications. When the researchers combined the findings from their study with two other smaller trials of corticosteroid therapy for the prevention of AF after cardiac surgery, they observed an overall benefit with steroid therapy compared with placebo. The relative risk of developing AF was reduced 33% with steroid therapy compared with placebo in this meta-analysis."The mechanisms by which corticosteroids prevent postoperative AF are not entirely clear. The concentration of complement C-reactive protein complex, the number of white blood cells, and the concentration of inflammatory cytokines?all markers of increased inflammatory reaction concentration?are higher in patients with postoperative AF than in patients who remain in sinus rhythm. Corticosteroids have anti-inflammatory activity and reduce exaggerated inflammatory reaction," the researchers write. They conclude, "intravenous administration of hydrocortisone is efficacious and well tolerated in the prevention of AF after cardiac surgery." "Larger trials will be needed to confirm our findings and determine short- and long-term safety of corticosteroids to prevent postoperative AF and other arrhythmias," they add. Reference...