NEW YORK (Reuters Health) – Perioperative corticosteroids reduce the risk of postoperative atrial fibrillation (AF) by more than 50% in patients undergoing cardiac surgery, according to a meta-analysis of trial data.

“This therapy has a very favorable risk/benefit ratio and should be considered in all patients undoing cardiopulmonary bypass,” co-author Dr. Paul E. Marik noted in an email to Reuters Health. Dr. Marik, formerly of Thomas Jefferson University, Philadelphia, is now at Eastern Virginia Medical School in Norfolk.

Current prophylactic measures to curb atrial fibrillation (AF) related to cardiac surgery, which occurs in up to 60% of patients, are inadequate, Dr. Marik and colleagues point out in the September issue of the Journal of Critical Care.

“Corticosteroids down-regulate activation of the proinflammatory response (including C-reactive protein) after cardiopulmonary bypass and have been suggested to reduce the risk of postoperative AF,” they note.

The investigators identified seven randomized placebo-controlled studies that evaluated the role of corticosteroids in preventing AF after cardiac surgery.

The studies involved a total of 1,046 patients. Cumulative corticosteroid dose was classified as low ( 10,000 mg/d).

Overall, corticosteroids had a significant protective effect against postoperative AF (odds ratio, 0.42; p = 0.0004), the researchers report. There was significant heterogeneity among the studies, however.

When the studies using low doses and very high doses of corticosteroids were excluded, the treatment effect was highly significant (odds ratio, 0.32; p < 0.00001) “with insignificant heterogeneity.” This effect was noted both with and without the concomitant use of beta-blockers, the study team notes. “Although the optimal dose, dosing interval, and duration of therapy is unclear, a single dose given at induction may be adequate,” Dr. Marik and colleagues conclude. Also, they note, given that elevated levels of C-reactive protein might have a role in neurocognitive decline after cardiac surgery, “the impact of treatment on this important complication requires investigation” as well. Reference:
J Crit Care 2009;24:458-463.