P2702Use of corticosteroids in the prophylaxis of atrial fibrillation after cardiac surgery (ECOFA study)

Abstract

Background: Atrial fibrillation (AF) is a frequent complication after cardiac surgery, associated with hemodynamic deterioration, prolonged hospital stay, increased risk of stroke and mortality. Although the pathogenesis of postoperative AF is multifactorial, inflammation may play a key role as a transient trigger mechanism. Purpose: To assess the effects of corticosteroids on the occurrence of postoperative AF. Methods: A prospective, randomized, double‐blind, placebo‐controlled clinical trial (ECOFA study) was designed. Patients without prior history of AF or atrial flutter and scheduled to undergo cardiac surgery (coronary artery bypass graft surgery, valve replacement or combined surgery) were randomized to receive either corticoids or placebo as follows: 500 mg of methylprednisolone or an equal volume of normal saline after induction of anesthesia and 4 mg of dexamethasone or placebo every 8 hours during 24 hours after surgery. All patients were treated with oral carvedilol before and after surgery. Patient rhythm was monitored by continuous telemetry during the immediate postoperative period and with a Holter recording throughout the patients' hospital stay. Results: A total of 104 consecutive patients were randomized to either of the two strategies (52 patients each arm), with similar distribution of cardiovascular risk factors and baseline characteristics. AF developed in 18,4% (9 patients) in the treatment group in contrast to 28,6% (14 patients) in the control group. In patients receiving corticosteroids, a relative decrease of 44% in the incidence of postoperative AF was documented [OR 0,56 CI 95% (0,33‐0,96, p=0,035)]. No difference in the incidence of postoperative complications and adverse effects due to corticosteroid therapy were observed. Conclusion: Prophylactic short‐term use of corticosteroids during and after cardiac surgery proved to be safe and effective in reducing the incidence of postoperative AF. (Table Presented).