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Effectiveness of Dexamethasone in Reducing Arrhythmia in Patients Undergoing Coronary Artery Bypass Grafting

Nata Kharimantara Nakamura1, Dudy Arman Hanafy1, Theresia Feline Husen2

  • 1Adult Cardiac Surgery, National Cardiovascular Center Harapan Kita, Jakarta, IDN.

Cureus
|October 22, 2024
PubMed

Insights

Dexamethasone reduced postoperative arrhythmias in on-pump coronary artery bypass grafting (CABG) patients by lowering inflammation. This effect was not observed in off-pump CABG procedures, though dexamethasone did decrease inflammatory markers in both groups.

Area of Science:

  • Cardiology
  • Pharmacology
  • Inflammation Research

Background:

  • Coronary artery bypass grafting (CABG) is associated with a significant risk of postoperative arrhythmias.
  • Inflammation plays a key role in the development of these arrhythmias.
  • The efficacy of dexamethasone in preventing arrhythmias during CABG is not fully understood, particularly differentiating between on-pump (ONCAB) and off-pump (OPCAB) procedures.

Purpose of the Study:

  • To evaluate the efficacy of dexamethasone in reducing postoperative arrhythmias in patients undergoing ONCAB and OPCAB.
  • To investigate the impact of dexamethasone on inflammatory markers (IL-6, CRP, procalcitonin) in the context of CABG surgery.
  • To explore the relationship between systemic inflammation and the occurrence of arrhythmias post-CABG.

Main Methods:

  • A single-center randomized controlled trial involving 120 patients undergoing ONCAB or OPCAB.
  • Patients received either dexamethasone or a placebo.
  • Postoperative arrhythmias were monitored hourly until discharge. Inflammatory markers were measured in all patients.

Main Results:

  • Overall, 24.2% of patients experienced arrhythmias.
  • Dexamethasone significantly reduced arrhythmias in the ONCAB group (p = 0.02) but not in the OPCAB group (p = 0.347).
  • Dexamethasone administration led to a significant decrease in IL-6, CRP, and procalcitonin in both ONCAB and OPCAB patients (p = 0.001).
  • Patients with arrhythmias exhibited higher levels of IL-6, CRP, and procalcitonin.

Conclusions:

  • Dexamethasone is effective in reducing postoperative arrhythmias following ONCAB, likely through the modulation of systemic inflammation.
  • While dexamethasone reduced inflammatory markers in both ONCAB and OPCAB patients, its anti-arrhythmic effect was specific to the ONCAB procedure.
  • Targeting inflammation with agents like dexamethasone may be a viable strategy for preventing arrhythmias in specific cardiac surgical contexts.

Keywords:
anti-inflammatoryarrhythmiacoronary artery bypass grafting (cabg)dexamethasoneinflammatory markeroff-pump coronary artery bypass (opcab) on-pump coronary artery bypass (oncab)

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