title: Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00442494.
authors.affiliation: Departments of Surgery and Internal Medicine, Kuopio University Hospital, and Computing Center of Kuopio University, Kuopio;
authors.forename: Jari
authors.initials: J
authors.lastname: Halonen
authors.forename: Pirjo
authors.initials: P
authors.lastname: Halonen
authors.forename: Otso
authors.initials: O
authors.lastname: Järvinen
authors.forename: Panu
authors.initials: P
authors.lastname: Taskinen
authors.forename: Tommi
authors.initials: T
authors.lastname: Auvinen
authors.forename: Matti
authors.initials: M
authors.lastname: Tarkka
authors.forename: Mikko
authors.initials: M
authors.lastname: Hippeläinen
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.forename: Juha
authors.initials: J
authors.lastname: Hartikainen
authors.forename: Tapio
authors.initials: T
authors.lastname: Hakala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001021:Aortic Valve; D001281:Atrial Fibrillation / Q000209:etiology* / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone