The Efficacy of Glucocorticoids for the Prevention of Atrial Fibrillation, or Length of Intensive Care Unite or Hospital Stay After Cardiac Surgery: A Meta‐Analysis

Abstract

SUMMARYAims: cardiopulmonary bypass and cardiac surgery are associated with a significant systemic inflammatory response that has been suggested playing a causative role in the development of perioperative atrial fibrillation (POAF). The goal of this meta-analysis was to determine the efficacy of glucocorticoid prophylaxis in preventing POAF, or length of intensive care unite (ICU) or hospital stay. Methods: A systematic electronic database literature search of Cochrane controlled trials register (2013, issue 4) and MEDLINE (1966 to April, 2013 was conducted using specific search terms for all relevant articles. Including criteria were: randomized controlled clinical trials, participants were adults (≥18 years of age) undergoing cardiac surgery, evaluated glucocorticoid prophylaxis in cardiac surgery with adequately reported data on incidence of POAF, or length of ICU or hospital stay. Results: Forty-two randomized controlled trials involving 7621 participants were included in the meta-analysis. Overall, glucocorticoids prophylaxis significantly lowered participants' risk of developing POAF (Relative Risk [RR] 0.77; 95% confidence interval [CI] 0.66-0.90), P < 0.01), reduced length of ICU stay by 0.25 day (95% CI À0.40 to À0.10, P < 0.01). Glucocorticoid prophylaxis in cardiac surgery was not associated with increased all-cause of infection (RR 0.68; 95% CI 0.58-0.78, P < 0.01) and mortality (RR 0.75; 95% CI 0.52-1.08, P = 0.12). Conclusions: Pooled evidence suggests that glucocorticoid prophylaxis may reduce the incidence of POAF. The beneficial effect on POAF is associated with reduced length of ICU and hospital stay, and infection rate.

Clinical efficacy of epicardial application of drug-releasing hydrogels to prevent postoperative atrial fibrillation

“…Converting the triamcinolone dosing to dexamethasone equivalence on the basis of total cumulative dose and relative potencies, which found the most effective in the reduction of POAF, seemed essential. 26 (2) Except for the transient predisposing mechanisms of POAF, sympathetic activation seems to be more relevant than inflammation and oxidative stress. Withdrawal from and treatment with amiodarone or betablockers have been shown to largely affect POAF incidence, whereas reducing oxidative stress or inflammation was less effective with corticosteroid.…”

Atrial fibrillation type modulates the clinical predictive value of neutrophil-to-lymphocyte ratio for atrial fibrillation recurrence after catheter ablation

“…Our results suggested that anti-inflammation could potentially be a therapeutic target for preventing LRAFs in PAF patients after the PVI. It is clearly evident that the greatest benefit from anti-inflammatory interventions such as steroids, colchicine, statins, aldosterone antagonists, and n-3 fatty acids, is observed in settings associated with a considerable inflammatory status due to tissue damage during catheter ablation [37] , [38] , [39] , [40] , [41] , [42] . Additionally, it might also be useful to use anti-inflammatory drugs in PAF patients with a high ΔNLR considering the comorbidities such as dyslipidemia and heart failure.…”

Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations: A Randomized Controlled Trial

“…Inflammation is believed to play a pivotal role in the etiology of atrial fibrillation in adult cardiac operations [24]. A recent meta-analysis suggested that glucocorticoids could effectively reduce the incidence postoperative atrial fibrillation [24].…”