Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial

JAMA. 2007 Apr 11;297(14):1562-7. doi: 10.1001/jama.297.14.1562.


Context: Atrial fibrillation (AF) is the most common arrhythmia to occur after cardiac surgery. An exaggerated inflammatory response has been proposed to be one etiological factor.

Objective: To test whether intravenous corticosteroid administration after cardiac surgery prevents AF after cardiac surgery.

Design, setting, and patients: A double-blind, randomized multicenter trial (study enrollment August 2005-June 2006) in 3 university hospitals in Finland of 241 consecutive patients without prior AF or flutter and scheduled to undergo first on-pump coronary artery bypass graft (CABG) surgery, aortic valve replacement, or combined CABG surgery and aortic valve replacement.

Intervention: Patients were randomized to receive either 100-mg hydrocortisone or matching placebo as follows: the first dose in the evening of the operative day, then 1 dose every 8 hours during the next 3 days. In addition, all patients received oral metoprolol (50-150 mg/d) titrated to heart rate.

Main outcome measure: Occurrence of AF during the first 84 hours after cardiac surgery.

Results: The incidence of postoperative AF was significantly lower in the hydrocortisone group (36/120 [30%]) than in the placebo group (58/121 [48%]; adjusted hazard ratio, 0.54; 95% confidence interval, 0.35-0.83; P = .004; number needed to treat, 5.6). Compared with placebo, patients receiving hydrocortisone did not have higher rates of superficial or deep wound infections, or other major complications.

Conclusion: Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery.

Trial registration: Identifier: NCT00442494.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / therapeutic use*
  • Aortic Valve
  • Atrial Fibrillation / etiology*
  • Atrial Fibrillation / prevention & control*
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiopulmonary Bypass
  • Coronary Artery Bypass
  • Double-Blind Method
  • Female
  • Heart Valve Prosthesis Implantation
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / therapeutic use*
  • Injections, Intravenous
  • Kaplan-Meier Estimate
  • Male
  • Meta-Analysis as Topic
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies


  • Anti-Inflammatory Agents
  • Hydrocortisone

Associated data