Addition of dexamethasone to magnesium decreases atrial fibrillation following coronary artery bypass grafting surgery

Objective Atrial fibrillation (AF) is a frequent complication that occurs within the first 5 days after cardiac surgery with a reported incidence of 20-40%. It might lead to significant morbidity, such as stroke and myocardial infarction. This prospective study aims to assess the potential benefit of adding a standard dose of dexamethasone to intravenous magnesium (Mg) in the case of AF after coronary artery bypass grafting (CABG). Patients and methods This was a prospective, randomized, parallel group study conducted in Ain Shams University Hospital.One hundred patients scheduled for elective primary isolated CABG were included. All patients had a preoperative sinus rhythm.Patients in the dexamethasone plus magnesium (DMg) group (50 patients) received two doses of intravenous dexamethasone (6 mg each) along with two doses of Mg supplementation (2 g each) within the first postoperative day.Patients in the Mg-only group (50 patients) received two doses of Mg supplementation (2 g each) at the similar time as patients in the DMg group.Continuous ECG recording was carried out for the first 72 h for all patients. Incidence of postoperative complications caused by dexamethasone was recorded. Measurements and main results All patients (50 in each group) completed the study. There was no significant difference between the two study groups with regard to demographic data, preoperative comorbidities, and surgical factors. The incidence of postoperative AF was significantly lower in the DMg group (P < 0.05) compared with the Mg-only group. There was no significant difference between the study groups regarding duration of postoperative ICU stay and extubation time. There was no significant difference between the study groups regarding incidence of chest infection (P = 0.7), sternal wound infection (P = 0.5), and urinary tract infection (P = 0.6). ConclusionAddition of dexamethasone (12 mg) to MgSO 4 (2 g) seems to decrease the incidence of new-onset AF in primary isolated elective CABG surgery without an increased incidence of complications.