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A prospective randomized trial to determine the effects of steroid on the incidence of postoperative atrial fibrillation after coronary artery bypass grafting surgery (CABG) Prasongsukarn, Kriengchai

Abstract

Background Atrial fibrillation remains one of the most common postoperative complications of coronary artery bypass grafting (CABG). Because of the additional hospital costs associated with this arrhythmia, owing to increased use of antiarrhythmic medications, diagnostic studies, and prolonged hospitalization, this subject continues to draw the interest of cardiac surgeons and cardiologists. Despite many clinical studies, there is still no consensus regarding the best prevention strategy for this arrhythmia. There are several mechanisms that explain why atrial fibrillation occurs after CABG, still the pathophysiological mechanism remains unclear, and therefore mutifactorial causes are likely. One of the mechanisms that we believe is inflammation around the sac of the heart and surgical trauma, including the generalized inflammation response induced by the heart-lung machine. As we know, steroid can decrease the body's response to trauma and inflammation and may reduce the chance of atrial fibrillation occurring. For this reason we design the study to assess the short-term effect of steroid on the incidence of postoperative atrial fibrillation after CABG. Methods This study was done during the time from August 2000 to February 2001 .Eighty-eight consecutive consenting patients were prospectively entered into a randomized, double blind, placebo-controlled trial to determine the efficacy of steroid on the incidence of atrial fibrillation after elective coronary artery bypass grafting. No patient had documented or suspected arrhythmias preoperatively. Two patients were excluded from the study due to Off-PumpCABG, forty-three patients received 1 gm of methyprednisolone before surgery and 4 mg of dexamethasone every 6 hours for one day after surgery, and forty-three patients received only placebo. Results Postoperative atrial fibrillation occurred in 9 of the 43 patients in the steroid group (21 percent) and 22 of the 43 patients in the placebo group (51 percent) (p=0.003). Minor postoperative complications occurred in 15 steroid patients (34 percent) and in 6 patients receiving placebo (14 percent). Major complications occurred in 4 patients who received steroid (9 percent) and in 2 who received placebo (5 percent) (p=0.052) Patients with atrial fibrillation were hospitalized for significantly longer days than were patients with normal sinus rhythm (median 8Vs.6 days, p=0.002); however, the length of hospital stay in Steroid group was 6 days compare with 7 days in Placebo group (p=0.337). Conclusions The use of prophylactic Short-Term Steroid Administration in patients undergoing coronary bypass grafting surgery reduced the incidence of postoperative atrial fibrillation by approximately 50 percent. Patients without postoperative atrial fibrillation had a shorter length of hospital stay. Overall, there was no significant difference between Steroid Group and Placebo Group with regard to the length of hospital stay. In this study, we found that Steroid had higher complications which may contribute to prolonged hospitalization.

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