الفهرس 
P OSTOPERATIVE A TRIAL F IBRILLATION P ATHOGENESISOnly 14 pages are availabe for public view
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Abstract
Abstract
Background: Cardiopulmonary bypass (CPB) and cardiac surgery are associated with a significant systemic inflammatory response that has been suggested playing a causative role in the development of postoperative atrial fibrillation (POAF). POAF after cardiac surgery is one of most common complications after cardiac surgery and is associated with significant morbidities. It may lead to hemodynamic instability; prolonged length of intensive care unit (ICU) and hospital stay.
Objectives: Assess the effectiveness of corticosteroids (CSs) in the prophylaxis of POAF in patients undergoing elective cardiac surgery in terms of reducing its incidence and decreasing the length of ICU and hospital stay.
Methods: This Randomized controlled clinical trial on 84 patients who underwent their first on-pump elective cardiac surgery in Ain Shams University Hospitals. Inclusion criteria consisted of elective first time coronary artery bypass grafting (CABG) or combined with valvular surgery, use of b-adrenergic blockade, and normal sinus rhythm. Exclusion criteria included a history of heart block, history of previous episodes of atrial fibrillation (AF) or flutter, history of peptic ulcer disease, permanent pacemaker, any documented or suspected supraventricular or ventricular arrhythmias, renal insufficiency (serum creatinine >20 milligram/deciliters (mg/dL)), uncontrolled diabetes mellitus, systemic bacterial or mycotic infection, patient underwent Redo cardiac surgery, patient underwent cardiac surgery without using cardiopulmonary bypass, urgent or emergency surgery. Patients were randomized into two equal groups (number (n) = 42 each) as the control group who underwent a standard cardiopulmonary bypass without any additional medication which will be performed under the supervision of a specialized elite and experts in their specialization, and the Methylprednisolone (MP) group who was given 1 g of methylprednisolone (divided into 250 mg every 6h once in the ICU),The primary outcome is the overall occurrence of postoperative AF during the first 72 hours after cardiac surgery. Secondary outcomes are the length of hospital stay, and ICU stay.
Results: POAF was found be significant lower in treatment group 16.7% (7 patients developed atrial fibrillation) versus 35.7% in the control group (15 patients developed atrial fibrillation) (p 0.047). In treatment group median length of ICU stay (3 days) and hospital stay (6 days) were lower compared with in control group median length of ICU stay (4 days) and hospital stay (9 days) (p <0.05). There were no statistically significant differences between the two groups with respect to gastrointestinal bleeding and overall mortality (2.4%). However, it was noticed that hyperglycemia and superficial wound infection were higher in the treatment group (9.5%) 4 patients vs. (7.1%) 3 patients in control group, but with no statistical significance (p >0.05).
Conclusion: Use of Corticosteroids is effective in prophylaxis of POAF in patients undergoing elective cardiac surgery in terms of reducing its incidence and decreasing the length of ICU and hospital stay.