Corticosteroids Reduce Post-Surgical Atrial Fibrillation

A new study had found that the use of hydrocortisone after cardiac surgery reduces the incidence of atrial fibrillation (AF).

Researchers from Kuopio University Hospital (Finland) conducted a randomized study at three university hospitals in Finland that included 241 patients without prior AF who were scheduled to undergo coronary artery bypass graft (CABG) surgery, aortic valve replacement, or combined CABG surgery and aortic valve replacement. Patients were randomized to receive either 100-mg hydrocortisone or matching placebo the evening of the operative day, then one dose every eight hours during the next three days.

The results showed that there were 94 patients who had AF during the first 84 hours after cardiac surgery. Patients randomized to the hydrocortisone group were significantly less likely to have AF than patients randomized to the placebo group (30% vs 48%); relative risk reduction was 37%. The first AF episode occurred later in patients randomized to the hydrocortisone group. The researchers also found that the incidence of in-hospital AF was significantly lower in the hydrocortisone group than in the placebo group. Compared with those receiving placebo, patients receiving hydrocortisone did not have higher rates of infections or major complications. The study was published in the April 11, 2007, issue of the Journal of the American Medical Association (JAMA).

"We conclude that intravenous administration of hydrocortisone is efficacious and well tolerated in the prevention of AF after cardiac surgery,” concluded Jari Halonen, M.D.. "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.”

Atrial fibrillation is the most common arrhythmia to occur after cardiac surgery. The incidence of AF has been reported to range between 20% and 40% after CABG surgery, and is even higher after heart valve surgery and combined valve and bypass surgery.


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