Effect of Dexamethasone on Atrial Fibrillation After Cardiac Surgery: Prospective, Randomized, Double-Blind, Placebo-Controlled Trial

Yared, Jean Pierre; Bakri, Mohamed H.; Erzurum, Serpil C.; Moravec, Christine S.; Laskowski, Daniel; Wagoner, David R. Van; Mascha, Edward J.; Thornton, Julie

doi:10.1053/j.jvca.2005.10.014

Cited by 77 publications

(44 citation statements)

References 45 publications

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“…Similarly, in a small study, low-dose methylprednisolone decreased plasma CRP levels and AF recurrence after electrical cardioversion [17] . On the other hand, a randomized doubleblind study did not show any beneficial effects of corticosteroids on postoperative AF and inflammation [59] . However, in a randomized study, Halonen et al [60] showed that corticosteroids decreased the incidence of postoperative AF and serum CRP levels.…”

Section: Hypothesesmentioning

confidence: 82%

Atrial fibrillation and inflammation

Özaydın

2010

WJC

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Atrial fibrillation (AF) is the most common clinical arrhythmia. Recent investigations have suggested that inflammation might have a role in the pathophysiology of AF. In this review, the association between inflammation and AF, and the effects of several agents that have anti-inflammatory actions, such as statins, polyunsaturated fatty acids, corticosteroids and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have been investigated.

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Section: Hypothesesmentioning

confidence: 82%

Atrial fibrillation and inflammation

Özaydın

2010

WJC

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“…20 As expected, several clinical trials of corticosteroids have shown an increase in the incidence of hyperglycemia as well as higher insulin requirements. 15,17,18,21,22 The Cochrane analysis did not fi nd an increased risk of infection in 15 studies including infectious complications as secondary outcomes. 5 Given that no study has been suffi ciently powered to assess this outcome, there remains a theoretical increased susceptibility to infection and poor wound healing associated with hyperglycemia that has not been elucidated in the existing studies.…”

Section: Hyperglycemia and Infectious Complicationsmentioning

confidence: 99%

Role of Corticosteroids during Cardiopulmonary Bypass

2014

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Corticosteroids are commonly used in the peri-operative setting for patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The infl ammatory response to CPB is associated with organ dysfunction and increased mortality. Corticosteroids reduce biochemical infl ammatory markers associated with CPB, however the impact on clinical outcomes is mixed. The purpose of this article is to evaluate the evidence of changes in clinical outcomes associated with the peri-operative administration of corticosteroids in patients undergoing cardiac surgery with CPB. Randomized, placebo-controlled trials and meta-analyses were reviewed for evidence evaluating the impact of corticosteroids on clinical outcomes including mortality, myocardial infarction, atrial fi brillation (AF), duration of intubation, length of intensive care unit (ICU) or hospital stay, hyperglycemia, and gastrointestinal complications. Most of the relevant studies are underpowered to assess major clinical outcomes. Although corticosteroids likely reduce the risk of AF, this needs to be evaluated when used in addition to or in lieu of other anti-arrhythmic agents. Evidence does not equivocally support the use of corticosteroids to improve clinical outcomes in cardiac surgery patients.

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“…Preoperative prophylaxis with β-blockers, amiodarone, corticosteroids, and, more recently, lipid-lowering agents has generally reduced the incidence of postoperative AF. [28][29][30][31] AUTONOMIC DYSFUNCTION Intense study is currently being devoted to defining the role of the autonomic nervous system in causing AF. The vagal innervation of the atria is widespread and asymmetrical, and vagal stimulation shortens the refractory period to various extents in different parts of the atrium, thereby increasing the likelihood of AF.…”

Section: Management Of Atrial Fibrillationmentioning

confidence: 99%