The efficacy and dosage effect of corticosteroids for the prevention of atrial fibrillation after cardiac surgery: A systematic review☆
Section snippets
Identification of trials
Our aim was to identify all relevant clinical trials that compared the incidence of AF after cardiac surgery in patients who were randomized to receive perioperative corticosteroids with that of patients who received placebo. We restricted our search to studies that enrolled adults; however, there was no restriction as to the type of patient, clinical setting, or language in which the study was reported. We used a multimethod approach to identify relevant studies for this review. Both authors
Results
The initial search strategy generated 22 citations; of these 16 were review articles, commentaries, or observational studies and were excluded from further analysis. A review of the bibliographies of the selected articles and review articles identified an additional study [21]. Seven studies therefore met our inclusion criteria and were included in the meta-analysis [21], [22], [23], [24], [25], [26], [27]. In 6 studies, patients were randomized to perioperative corticosteroids or placebo. In
Discussion
This meta-analysis suggests that the use of perioperative corticosteroids reduces the risk of postoperative AF by greater than 50%. This effect was noted both with and without the concomitant use of β-blockers. However, the effect appeared to be dependent of the dosing regimen used, with both very high and low dosages of corticosteroids being ineffective in contrast to the moderate- and high-dosage groups. This finding is in keeping with the critical care literature, in which moderate dose but
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The authors have no financial interest in any of the products mentioned in this paper.