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A Randomized Controlled Trial

Jari Halonen, MD; Pirjo Halonen, PhD; Otso Järvinen, MD, PhD; Panu Taskinen, MD; Tommi Auvinen, MD; Matti Tarkka, MD, PhD; Mikko Hippeläinen, MD, PhD; Tatu Juvonen, MD, PhD; Juha Hartikainen, MD, PhD; Tapio Hakala, MD, PhD

JAMA. 2007;297:1562-1567.

Context  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.

Design, Setting, and Patients  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.

Intervention  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.

Main Outcome Measure  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.

Conclusion  Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery.

Trial Registration  clinicaltrials.gov Identifier: NCT00442494

Author Affiliations: Departments of Surgery and Internal Medicine, Kuopio University Hospital (Drs J. Halonen, Auvinen, Hippeläinen, and Hartikainen), and Computing Center of Kuopio University (Dr P. Halonen), Kuopio; Heart Center, Tampere University Hospital, Tampere (Drs Järvinen and Tarkka); and Department of Surgery, Oulu University Hospital (Drs Taskinen and Juvonen), and Department of Surgery, North Karelia Central Hospital (Dr Hakala), Joensuu, Finland.

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