Use of short-term steroids in the prophylaxis of atrial fibrillation after cardiac surgery

Zeyad Al-Shawabkeh, Khalid Al-Nawaesah, Razi Abu Anzeh, Hael Al-Odwan, Wasfi Azyoud Bashar Al-Rawashdeh, Haetham Altaani, Zeyad Al-Shawabkeh, Khalid Al-Nawaesah, Razi Abu Anzeh, Hael Al-Odwan, Wasfi Azyoud Bashar Al-Rawashdeh, Haetham Altaani

Abstract

Objectives: To assess the effectiveness of corticosteroids in the prophylaxis of postoperative atrial fibrillation (AF) in patients undergoing elective coronary artery bypass grafting or valvular heart surgery in terms of reducing its incidence and decreasing the length of hospital stay.

Methods: This prospective double blinded randomized study was conducted at Queen Alia Heart Institute (Amman, Jordan) from June 2014 to June 2015 on 340 patients who underwent their first on-pump elective coronary artery bypass grafting (CABG) alone or combined with valvular surgery. Inclusion criteria consisted of elective first time CABG or combined with valvular surgery, use of β-adrenergic blockade, and normal sinus rhythm. Exclusion criteria included a history of heart block, previous episodes of AF or flutter, uncontrolled diabetes mellitus, history of peptic ulcer disease, systemic bacterial or mycotic infection, permanent pacemaker, and any documented or suspected supraventricular or ventricular arrhythmias. Patients were randomized into two equal groups (n = 170 each), then each group was subdivided into patients who underwent CABG alone (n = 120), and patients underwent valvular heart surgery with or without CABG (n = 50). In the treatment group, patients were given 1 g of methylprednisolone before cardiopulmonary bypass then 100 mg of hydrocortisone every 8 hours for the first 3 days postoperatively. The primary endpoint was the overall occurrence of postoperative AF.

Results: AF developed in 21.1% (36 patients) in the treatment group in contrast to 38.2% (65 patients) in the control group (p < 0.05). In the subdivided groups (CABG only), approximately 20% (24 patients) developed AF in the treatment group in contrast to 35% (42 patients) in the control group (p < 0.05). In the other group, (CABG + VALVE) 24% (12 patients) developed AF compared with 46% (23 patients) in the control group (p < 0.05). The length of hospital stay was 6.02 ± 11.23 days in the treatment group while it was 5.98 ± 1.86 days in the control group, which was found to be statistically nonsignificant. No statistical significant difference in the rate of postoperative complications including mediastinitis as well superficial wound infections was observed between the two groups.

Conclusion: Prophylactic short-term use of steroids both intraoperatively and postoperatively proved to be safe and effective in reducing the incidence of postoperative AF in patients undergoing CABG alone or combined with valve surgery.

Keywords: Atrial fibrillation, Complications, Corticosteroids, Postoperative, Prophylaxis.

Figures

Figure 1
Figure 1
Summary of the study results. AF = atrial fibrillation; CABG = coronary artery bypass graft.

References

    1. Ali-Hassan-Sayegh S., Mirhosseini S.J., Haddad F., Karimi-Bondarabadi A.A., Shahidzadeh A., Weymann A. Protective effects of corticosteroids in coronary artery bypass graft surgery alone or combined with valvular surgery: an updated and comprehensive meta-analysis and systemic review. Interact Cardiovasc Thorac Surg. 2015;20:825–836.
    1. Halonen J., Halonen P., Järvinen O., Taskinen P., Auvinen T., Tarkka M. Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA. 2007;297:1562–1567.
    1. Prasongsukarn K., Abel J.G., Jamieson W.R., Cheung A., Russell J.A., Walley K.R. The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized trial. J Thorac Cardiovasc Surg. 2005;130:93–98.
    1. Raja S.G., Benedettol L.L. Off-pump coronary artery bypass grafting: misperceptions and misconceptions. World J Methodol. 2014;4:6–10.
    1. Kristeller J.L., Jankowski A., Reinaker T. Role of corticosteroids during cardiopulmonary bypass. Hosp Pharm. 2014;49:232–236.
    1. Kaplan M., Kut M.S., Icer U.A., Demirtas M.M. Intravenous magnesium sulfate prophylaxis for atrial fibrillation after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2003;125:344–352.
    1. Kohno H., Koyanagi T., Kasegawa H., Miyazaki M. Three-day magnesium administration prevents atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg. 2005;79:117–126.
    1. Miller S., Crystal E., Garfunkel M., Lau C., Lashevsky I., Connolly S.J. Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis. Heart. 2005;91:618–623.
    1. Archbold R.A., Zaman A.G. Magnesium for atrial fibrillation after coronary artery bypass graft surgery: its role in aetiology and prevention. Crit Care Resusc. 2000;2:260–268.
    1. Burgess D.C., Kilborn M.J., Keech A.C. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J. 2006;27:2846–2857.
    1. Cook R.C., Humphries K.H., Gin K., Janusz M.T., Slavik R.S., Bernstein V. Prophylactic intravenous magnesium sulphate in addition to oral β-blockade does not prevent atrial arrhythmias after coronary artery or valvular heart surgery: a randomized, controlled trial. Circulation. 2009;120(11 Suppl.):5163–5169.
    1. Ho K.M., Lewis J.P. Prevention of atrial fibrillation in cardiac surgery, time to consider a multimodality pharmacological approach. Cardiovasc Ther. 2010;28:59–65.
    1. Cappabianca G., Rotunno C., de Luca Tupputi Schinosa L., Ranieri V.M., Paparela D. Protective effects of steroids in cardiac surgery: a meta-analysis of randomized double-blind trials. J Cardiothorac Vasc Anesth. 2011;25:156–165.
    1. Teoh K.H., Bradley C.A., Gauldie J., Burrows H. Steroid inhibition of cytokine-mediated vasodilation after warm heart surgery. Circulation. 1995;92(Suppl. 2):II347–II353.
    1. Engelman R.M., Rousou J.A., Flack J.E., 3rd, Deaton D.W., Kalfin R., Das D.K. Influence of steroids on complement and cytokine generation after cardio pulmonary bypass. Ann Thorac Surg. 1995;60:801–804.
    1. Wan S., Leclerc J.L., Vincent J.L. Cytokine responses to cardiopulmonary bypass. Lessons learned from cardiac transplantation. Ann Thorac Surg. 1997;63:269–276.
    1. Dernellis J., Panaretou M. Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation. Eur Heart J. 2004;25:1100–1107.
    1. Yared J.P., Starr N.J., Torres F.K., Bashour C.A., Bourdakos G., Piedmonte M. Effects of single dose, postinduction dexamethasone on recovery after cardiac surgery. Ann Thorac Surg. 2000;69:1420–1424.
    1. Ho K.M., Tan J.A. Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis. Circulation. 2009;119:1853–1866.
    1. Marik P.E., Fromm R. The efficacy and dosage effect of corticosteroids for the prevention of atrial fibrillation after cardia surgery: a systematic review. J Crit Care. 2009;24:458–463.
    1. Halvorsen P., Raeder J., White P.F., Almdahl S.M., Nordstrand K., Saatvedt K. The effect of dexamethasone on side effects after coronary revisualization procedures. Anseth Analg. 2003;96:1578–1583.
    1. Dieleman J.M., van Paassen J., van Dijk D., Arbous M.S., Kalkman C.J., Vandenbroucke J.P. Prophylactic corticosteroids for cardiopulmonary bypass in adults. Cochrane Database Syst Rev. 2011;5:CD005566.
    1. Whitlock R.P., Chan S., Devereaux P.J., Sun J., Rubens F.D., Thorlund K. Clinical benefits of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials. Eur Heart J. 2008;29:2592–2600.

Source: PubMed

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