Effect of dexamethasone on atrial fibrillation after cardiac surgery: prospective, randomized, double-blind, placebo-controlled trial.
OBJECTIVE
The purpose of this study was to assess the effect of preoperative dexamethasone (DEX) on the occurrence of postoperative atrial fibrillation (AF).


METHODS
Prospective, randomized, double-blind, placebo-controlled clinical trial.


METHODS
Tertiary referral center.


METHODS
Seventy-eight adult patients undergoing combined valve and coronary artery bypass graft (CABG) surgery were randomized to receive either DEX or placebo.


METHODS
The DEX group received dexamethasone, 0.6 mg/kg, after induction of anesthesia, and the placebo group received an equal volume of normal saline. Interleukin (IL)-6, -8, and -10; tumor necrosis factor alpha; and endothelin (ET)-1 were measured preoperatively and on postoperative days (POD) 1, 2, and 3. Complement (C-4) and C-reactive protein (CRP) were measured preoperatively and on POD 2. Exhaled nitric oxide (NO) was measured preoperatively, 15 minutes after aortic unclamping, and 1 hour after intensive care unit admission.


RESULTS
No significant difference in the incidence of AF was found between the placebo (41%) and DEX groups (30%) (95% confidence interval [-11%, 34%); p = 0.31). DEX significantly reduced at least 1 postoperative level of IL-6, IL-8, IL-10, CRP, and exhaled NO. DEX did not affect ET-1 or C-4 levels. IL-10 on POD 3 was positively correlated with postoperative hospital length of stay (r = 0.30, p = 0.01). Increased levels of IL-8 and IL-10 on POD 1 were positively correlated with the intubation time (r = 0.31, p = 0.01; r = 0.30, p = 0.01, respectively). Conversely, C-4 on POD 2 was negatively correlated with the intubation time and intensive care unit length of stay (r = -0.32, p = 0.006; r = -0.30, p = 0.01, respectively).


CONCLUSIONS
DEX did not affect the incidence of AF in patients undergoing combined CABG and valve surgery. However, it did modulate the release of several inflammatory and acute-phase response mediators that are associated with adverse outcomes.
Yared
Jean-Pierre
JP
Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. yaredj@ccf.org
Bakri
Mohamed H
MH
Erzurum
Serpil C
SC
Moravec
Christine S
CS
Laskowski
Daniel M
DM
Van Wagoner
David R
DR
Mascha
Edward
E
Thornton
Julie
J
D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D002097:C-Reactive Protein / Q000032:analysis / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003181:Complement C4 / Q000032:analysis / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000379:methods; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D019332:Endothelin-1 / Q000097:blood / Q000187:drug effects; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007378:Interleukins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D010919:Placebos; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000187:drug effects
D003181:Complement C4; D019332:Endothelin-1; D005938:Glucocorticoids; D007378:Interleukins; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide; D012965:Sodium Chloride; D003907:Dexamethasone; D002097:C-Reactive Protein