JAMA 4/11/07 – A rare surgery related article for today by Halonen(s) et al. from JAMA.
For unclear reasons the incidence of A-fib after CABG and valve surgery is pretty high (20-40%). One theory is that it is somehow related to an inflammatory response, and maybe can be prevented with steroids.
This double blind RCT compared Q8 hr hydrocortisone for 3 days postop to placebo for the incidence of atrial fibrillation. They found the incidence of postoperative AF was significantly lower in the hydrocortisone group (30%) than in the placebo group (48%) with a NNT of 5.6. And the incidence of infection was similar in both groups.
Interesting because I remember blogging about an article that showed an increase in A-fib with pulse dose steroids in Annals last year. What gives? Well the prior study didnt involve surgery and it was observational – but I was still suprised at the opposite conclusions…. hopefully it will become more clear when the exact mechanism is better worked out
