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

Introduction Coronary artery bypass grafting (CABG) carries the risk of postoperative arrhythmias. Our study focusses on the efficacy of dexamethasone in both on-pump CABG (ONCAB) and off-pump CABG (OPCAB). Methods This single center randomized control trial was conducted from July 1st, 2018 to January 20th, 2019 in patients undergoing conventional ONCAB and OPCAB at the National Cardiovascular Center Harapan Kita (NCCHK). All arrhythmia incidents were recorded postoperatively with routine monitoring done every hour until the patient was discharged. Results One hundred and twenty patients were included in the study and arrhythmias occurred in 24.2% of patients. In the ONCAB groups, there was an association between dexamethasone versus placebo in reducing the incidence of arrhythmias (p = 0.02; OR 0.23 [0.064-0.831]). However, in patients who underwent OPCAB, there was no association between dexamethasone administration and the incidence of arrhythmias (p = 0.347; OR 0.55 [0.157-1.931]). Patients on dexamethasone in both ONCAB and OPCAB groups showed a significant decrease in IL-6, CRP, and procalcitonin (p = 0.001 for all). Overall, arrhythmic subjects had significantly higher levels of inflammatory markers IL-6 (p = 0.013), CRP (p = 0.025), and procalcitonin (p = 0.001). Conclusion Dexamethasone reduced postoperative arrhythmias, likely by modulating systemic inflammation, as shown by the decrease in inflammatory markers in ONCAB patients compared to those given a placebo.