Steroid Use for Recovery of Advanced Atrioventricular Block Immediately After Valvular Surgery (Survival): A Preliminary Randomized Clinical Trial Publisher Pubmed



Ghodsi S¹ ; Masoudkabir F^{1, 2} ; Hosseini Z¹ ; Davarpasand T² ; Yavari N¹ ; Mohebi M¹ ; Talasaz AH² ; Jalali A¹ ; Ahmaditafti SH³ ; Bagheri J³ ; Hasanzadeh H³ Show Affiliations
Source: Journal of Cardiovascular Electrophysiology Published:2022

Abstract

Background: Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation-mediated injury might trigger AVB. Methods: Patients with advanced postoperative AVB were randomly assigned to receive either dexamethasone (0.4 mg/kg, maximum 30 mg/day) intravenously for 3 days or conservative care only. Primary endpoint was recovery rate in Day 5 since randomization. Secondary endpoints were recovery rate in Day 7 and Day 10, cumulative AVB time, permanent pacemaker (PPM) implantation rate, length of stay in critical care units, and postoperative major adverse events (MAE). Results: We enrolled 139 subjects (48.9% male) with mean age of 59.9 years randomly allocated to intervention group (n = 69) and control group (n = 70). Dexamethasone led to higher recovery rates at Day 5 (82.6% vs. 62.9%, p =.009) and Day 7 (88.4% vs. 61.4%, p <.0001) respectively. This benefit ceased at Day 10 (83.05% vs. 78.6%, p =.547). Median cumulative AVB time was shorter in dexamethasone group compared with control group (41 h vs. 64 h, p =.044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs. 17.1%, respectively, p =.849). Median length of stay in intensive care unit (ICU) (10 days vs. 12 days, p =.03) and MAE (17.4% vs. 25.7%, p =.133) tended to be lower with dexamethasone. Conclusion: Dexamethasone may serve as a safe and effective medication to help hasten recovery of advanced AVB after valvular surgery. © 2022 Wiley Periodicals LLC.