RT Journal
A1 Halonen J, Halonen P, Järvinen O, et al
T1 Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: A randomized controlled trial
JF JAMA
JO JAMA
YR 2007
FD April 11
VO 297
IS 14
SP 1562
OP 1567
DO 10.1001/jama.297.14.1562
UL http://dx.doi.org/10.1001/jama.297.14.1562
AB 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