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Corticosteroids in Atrial Fibrillation: Friends or Foes?
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I read with great interest the recent contribution by van der Hooft et al,1 which provided epidemiological evidence for an association between high-dose corticosteroid exposure (oral or parenteral steroid at a daily dose of  7.5 mg of prednisone equivalents) and the development of AF. A direct arrhythmogenic effect of these agents was also speculated, and some potential triggering mechanisms were proposed.1
I consider that some relevant issues merit further clarification because inconsistent findings on this topic have been reported in the literature. The authors do not discuss the current evidence regarding the role of inflammation and oxidative stress in AF, and more importantly, some recent studies indicating favorable effects of corticosteroids are not mentioned.
Accumulating evidence suggests that inflammation and oxidative stress may have a significant impact on atrial remodeling, which favors AF development and perpetuation.2-3 Corticosteroids represent major anti-inflammatory drugs with immunomodulatory and indirect antioxidant properties.2-3 Dernellis and Panaretou4 . . . [Full Text of this Article]
AUTHOR INFORMATION
Panagiotis Korantzopoulos, MD, PhD
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RELATED ARTICLE
Corticosteroids and the Risk of Atrial Fibrillation
Cornelis S. van der Hooft, Jan Heeringa, Guy G. Brusselle, Albert Hofman, Jacqueline C. M. Witteman, J. Herre Kingma, Miriam C. J. M. Sturkenboom, and Bruno H. Ch. Stricker
Arch Intern Med. 2006;166(9):1016-1020.
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