Intraoperative dexamethasone on left atrial function and postoperative atrial fibrillation in cardiac surgical patients

Introduction

Postoperative new-onset atrial fibrillation (PNAF) is very common after cardiac surgery. The inflammatory response due to surgery and cardiopulmonary bypass (CPB) may contribute to PNAF by inducing atrial dysfunction [1]. Corticosteroids reduce the inflammatory response and may thus reduce atrial dysfunction and PNAF [2]. The aim of this study was to determine whether dexamethasone protects from left atrial dysfunction and PNAF in cardiac surgical patients.

Methods

Patients undergoing cardiac surgery were randomized to a single dose of dexamethasone (1 mg/kg) or placebo after inducing anesthesia. Transesophageal echocardiography was performed in patients after CPB. The primary outcome was left atrial total ejection fraction (LA-TEF) after sternal closure; secondary outcomes included left atrial diameter and PNAF, detected by Holter monitoring.

Results

Sixty-two patients were included. Baseline characteristics were well balanced. Postoperative LA-TEF was 36.4% in the dexamethasone group and 40.2% in the placebo group (P = 0.15) (Figure 1). Secondary echocardiographic outcomes were also insignificant (Table 1). The incidence of PNAF was 30% in the dexamethasone group and 39% in the placebo group (P = 0.47).

Figure 1

Primary outcome preoperatively and postoperatively in dexamethasone and placebo groups.

Table 1 Secondary postoperative echocardiographic parameters in both groups

Conclusion

Intraoperative high-dose dexamethasone did not have any protective effect on postoperative LA-TEF or dimension and did not reduce the risk of PNAf in cardiac surgical patients.