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To the Editor: In their randomized controlled trial of corticosteroids for prevention of atrial fibrillation (AF) after cardiac surgery, Dr Halonen and colleagues¹ found that intravenous hydrocortisone therapy reduced the incidence of postoperative AF. In the study protocol, all patients were administered oral metoprolol according to their heart rate during the postoperative 84 hours. -Blockers such as metoprolol may prevent postoperative AF, with a meta-analysis suggesting that -blockers could reduce postoperative AF as much as sotalol or amiodarone.² Therefore, the metoprolol dose may have been an important confounder. The authors did not indicate whether there were any differences in overall oral metoprolol dose between the corticosteroid and the placebo groups in their study.

In addition, the authors recently reported that intravenous metoprolol is more effective than oral metoprolol in the prevention of AF after cardiac surgery.³ It would therefore be valuable to study whether the intravenous combination therapy of hydrocortisone . . . [Full Text of this Article]

Jaewon Oh, MD; Ji-Hyung Chung, PhD; Seok-Min Kang, MD, PhD
smkang@yumc.yonsei.ac.kr
Yonsei University College of Medicine
Seoul, Korea

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