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To the Editor: Dr Halonen and colleagues¹ found that intravenous hydrocortisone significantly reduced the incidence of AF after cardiac surgery with cardiopulmonary bypass (adjusted hazard ratio, 0.54; 95% confidence interval, 0.35-0.83; P = .004; number needed to treat, 5.6). The statistical analysis accounted for established predictors of AF, such as age, sex, ejection fraction, type of operation, pulmonary disease, and coronary artery disease.

However, the article did not provide detail about important factors specific to the perioperative atrial milieu. Perioperative exposure to magnesium, statins, and epicardial pacing may significantly affect the incidence of AF,^2-3 but the authors do not indicate whether exposure to these variables significantly varied between the placebo and hydrocortisone groups. The effects of these potential confounders could significantly bias the results of the trial.

Furthermore, there is a potential effect of perioperative hyperglycemia due to administration of hydrocortisone for 72 hours. Hyperglycemia and its management with insulin have . . . [Full Text of this Article]

John G. T. Augoustides, MD
yiandoc@hotmail.com
Department of Anesthesiology and Critical Care
Hospital of the University of Pennsylvania
Philadelphia

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