The Effects of Steroids on the Occurrence of Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery: A Prospective Randomized Trial

Prasongsukarn, Kriengchai; Abel, James G.; Jamieson, W.R. Eric

doi:10.1016/j.accreview.2005.10.065

Cited by 25 publications

(52 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All patients were treated with a BB postoperatively. Patients randomised to steroids had a significantly lower incidence of postoperative AF (21% vs 51%, p = 0.03) 14. Although these pharmacologic agents show significant promise, more studies need to be performed to evaluate their role in AF prevention before they can be routinely be recommended.…”

Section: Managementmentioning

confidence: 99%

The management of atrial fibrillation after cardiac surgery

Rho

2008

Heart

View full text Add to dashboard Cite

Section: Managementmentioning

confidence: 99%

The management of atrial fibrillation after cardiac surgery

Rho

2008

Heart

View full text Add to dashboard Cite

“…The negative finding related to AF contradicts clinical literature involving patients with spontaneous AF associated with elevated CRP levels 10 and patients with postoperative AF 11,12 . There are several potential explanations for this discrepancy, including the fact that all of the clinical studies used glucocorticoids other than prednisone.…”

Section: Editorial Commentmentioning

confidence: 90%

Preventing Atrial Flutter by Preventing Inflammation

Marcus

Scheinman

2007

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Editorial CommentAlthough atrial arrhythmias are the most common tachyarrhythmias encountered in clinical practice, affecting several million patients in the United Stated alone, the exact etiology remains unknown.1 Several risk factors have been established and are well known, including older age, hypertension, or the postoperative state, 2 but the mechanistic connection between these demographic, disease, or situational conditions and a propensity to develop atrial arrhythmias is largely missing.Recently, the case for an important association between inflammation and arrhythmias in human subjects has been building, both for postoperative 3 and spontaneous arrhythmia. 4 The beginnings of the biological plausibility that motivated much of this work arose from the canine sterile pericarditis model first introduced by Dr. Waldo in 1986. 5 This contribution was significant not only in providing a model wherein atrial arrhythmias could be reliably induced, but also in demonstrating that inflammation was sufficient to make an animal prone to sustained atrial flutter (AFL) and atrial fibrillation (AF). In this issue of the Journal, Goldstein et al. take this model a step further: by examining the effects of steroids on the induction of atrial arrhythmias in the sterile pericarditis model, the authors enter the critical arena of novel therapeutics. 6 The authors have elegantly and clearly proven that the intense inflammatory response is indeed proarrhythmic. Moreover, they showed that the consistent findings of inducible sustained AFL were well correlated with an intense inflammatory response and elevated CRP levels in the control animals. These experiments are very persuasive. Indeed, the primary purpose of understanding the etiology of these arrhythmias should be to develop efficacious and safe treatments that can readily address the root cause underlying the disease.In their study, sterile pericarditis was created in 23 dogs, 11 of whom were pretreated with oral prednisone (40 mg twice daily). The drug was continued in the treatment group until the fourth postoperative day. The primary positive finding of the study was the inability to induce sustained AFL in the dogs treated with prednisone. Consistent with previous studies from the same group, sustained AFL was induced in all of the control dogs. In interpreting these data, two points bear emphasizing: first, neither AF nor AFL occurred spontaneously using the sterile pericarditis model (electrical stimulation was required). Second, sustained AFL was defined as AFL lasting > 10 minutes-importantly, at least one of This finding is particularly important because it demonstrates that inflammation can result in a sustained arrhythmia with a persistent (presumably single) electrical circuit and that this circuit can be prevented from forming with steroids. The concept that AF arises due to an abnormal atrial substrate (at least in some patients) is generally well accepted; 7,8 however, other more stable or single-circuit arrhythmias are typically thought to require a...

show abstract

“…All OHT patients received perioperative immunosuppression and only five patients were discharged without prednisone (all five receiving muromonab‐CD3 instead). Steroids reduce the risk of postoperative AF and could have biased our results in favor of OHT . These limitations should, however, be viewed in light of the remarkably low occurrence of postoperative AF among OHT recipients (6.5%) despite presence of factors predisposing to high postoperative AF in cardiac surgery patients (major cardiac surgery, insults to the donor heart in harvest and transport, immune response to the foreign organ, use of catecholaminergic drugs, and infrequent use of β ‐blockers or antiarrhythmics) .…”

Section: Limitationsmentioning

confidence: 96%