Steroids Help in Heart Surgery

(Ivanhoe Newswire) -- New research reveals patients who get corticosteroids after heart surgery have a much lower risk of atrial fibrillation in the days following surgery.

Researchers from Kuopio University Hospital in Finland studied 241 patients who were undergoing heart bypass surgery, aortic valve replacement surgery, or a combination of the two surgeries. Some patients received either 100 milligrams of the steroid hydrocortisone or a placebo the night of their surgery and one dose every eight hours over the next three days. None of the patients had a prior history of atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia to occur after heart surgery. It causes the heart's two small upper chambers to quiver instead of beat effectively. Because the blood isn't pumped completely out of the upper chambers, it may pool and clot. If a piece of a blood clot leaves the heart and becomes lodged in an artery in the brain, it causes a stroke. Atrial fibrillation happens in up to 40 percent of patients after heart bypass surgery and the risk is even higher after heart valve surgery. Researchers say a high inflammatory response after surgery is believed to be partially responsible for atrial fibrillation.

Of the 241 patients in this study, 94 had atrial fibrillation during the first 84 hours after surgery. Patients who were randomized to receive hydrocortisone were 37-percent less likely (30 percent developed AF) to have atrial fibrillation than patients who received a placebo (48 percent developed AF). Authors also note the first atrial fibrillation episode happened later in the hydrocortisone group and the incidence of developing atrial fibrillation while in the hospital was also significantly lower in this group.

Study authors write, "Intravenous administration of hydrocortisone is efficacious and well tolerated in the prevention of AF after cardiac surgery. Larger trials will be needed to confirm our findings and determine short- and long-term safety of corticosteroids to prevent postoperative AF and other arrhythmias."

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SOURCE: The Journal of the American Medical Association, 2007;297:1562-1567