Sotalol and/or Steroids for the Prevention of Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

Background: Atrial fibrillation (AF) is the most common arrhythmia to occur after cardiac surgery. We designed this prospective, randomized, double-blinded study to evaluate the effect of perioperative administration of sotalol and/or steroids on the incidence of AF after coronary artery bypass graft (CAGB) surgery.Methods: 240 patients were assigned into four treatment groups (steroid group, sotalol-steroid group, sotalol group and placebo group). Patients in the steroid group received 1000 mg of methylprednisolone before cardiopulmonary bypass (CPB) and 4 mg of dexamethasone every six hours for a total of four doses. Patients in the sotalol-steroid group received sotalol 80 mg tablet 24 h before surgery and continued for up to four days postsurgery, as well as 500 mg of methyl¬prednisolone before CPB and 4 mg of dexamethasone every six hours for a total of four doses. Patients in the sotalol group received sotalol 80 mg tablet, twice daily, 24 h before surgery and continued for up to four days postsurgery. Patients in the placebo group received placebo tablets and infusions.Results: The percentages of patients who had AF were lower in the steroid (16.7%), sotalol-steroid (18.3%) and sotalol (21.7%) groups compared to the placebo group (38.3%). On cardiovascular intensive care unit admission, cardiac index was significantly lower in the sotalol group and blood glucose levels were significantly higher in the steroid group. More patients in the sotalol group developed symptomatic brady-cardia.Conclusion: Sotalol-steroids combination decreases AF after CAGB surgery with a high degree of efficacy and safety.