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(Circulation. 2008;118:467-468.)
© 2008 American Heart Association, Inc.

Editorial

Preventing Atrial Fibrillation After Cardiac Surgery

A New Method Using an Old Tool

Gregory M. Marcus, MD; Jeffrey E. Olgin, MD

From the Division of Cardiology, Electrophysiology Section, University of California, San Francisco.

Correspondence to Jeffrey E. Olgin, MD, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, 500 Parnassus Ave, MUE 434, San Francisco, CA, 94143–1354. E-mail olgin@medicine.ucsf.edup

Key Words: Editorials • fibrillation • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Atrial fibrillation (AF) after cardiac surgery remains a common problem, resulting in prolonged hospital stays and added morbidity for a substantial proportion of patients.¹ Although traditional therapies with antiarrhythmic agents can suppress this common arrhythmia in nearly half of all cases, generally >1 in 10 of all cardiac surgery patients will have AF despite the best available therapies, and amiodarone, the most potent conventional agent, carries the risk of numerous toxicities.²

Article p 476

Recent studies have sought to address more directly the pathophysiology of AF in this setting, building on data that the arrhythmia may occur as a result of surgically induced inflammation.³ A randomized trial of atorvastatin versus placebo initiated 7 days before surgery demonstrated a 22% absolute risk reduction and an adjusted 61% reduction in the odds of developing AF.⁴ However, 35% of subjects in the treated arm still developed AF postoperatively. In addition, although this study provided an important proof of principle, it is unlikely that it will radically change clinical practice because most cardiac surgery patients will still undergo therapy with statins because of their coronary disease. In an attempt to test the antiinflammatory hypothesis even more directly, investigators in Finland performed a placebo-controlled, randomized clinical trial of hydrocortisone in cardiac surgery patients and demonstrated a 46% reduction in the risk of AF.⁵ Once again, however, 30% of those in the treatment arm exhibited AF. Although no major complications were observed, trepidation regarding the administration of high-dose steroids in the immediate postoperative setting may prevent . . . [Full Text of this Article]