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J Thorac Cardiovasc Surg 2005;130:93-98
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: A prospective randomized trial

St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

Received for publication February 6, 2004; revisions received August 27, 2004; accepted for publication September 15, 2004.

^_* Address for reprints: Samuel V. Lichtenstein, MD, PhD, St Paul’s Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6 Canada (Email: SLichtenstein{at}providencehealth.bc.ca).

OBJECTIVE: Atrial fibrillation remains one of the most common postoperative complications of coronary artery bypass grafting. Despite many clinical studies, there is still no consensus regarding the best prevention strategy for atrial arrhythmia. A randomized, double-blind, placebo-controlled trial was conducted to determine the effect of steroids on the occurrence of atrial fibrillation after elective coronary artery bypass grafting.

METHODS: Eighty-eight consecutive patients were prospectively entered in this study. No patient had documented or suspected arrhythmias before surgery. Forty-three patients received 1 g of methylprednisolone before surgery and 4 mg of dexamethasone every 6 hours for 1 day after surgery, and 43 patients received only placebo. The primary end point was the overall occurrence of postoperative atrial fibrillation.

RESULTS: Postoperative atrial fibrillation occurred in 9 (21%) of the 43 patients in the steroid group, as compared with 22 (51%) of the 43 patients in the placebo group (P = .003). Minor postoperative complications occurred in 15 steroid patients (35%) and in 6 patients (14%) receiving placebo (P= .01). Major complications occurred in 4 patients who received steroids (9%) and in 2 patients (5%) who received placebo (P = .68; for all complications, P = .05).

CONCLUSIONS: Prophylactic short-term steroid administration in patients undergoing coronary artery bypass grafting significantly reduced postoperative atrial fibrillation. In this study, there was no significant difference between the steroid group and the placebo group with regard to the length of hospital stay; however, the steroid group had more complications, which may contribute to prolonged hospitalization.

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