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Use of Oral Steroid and its Effects on Atrial Fibrillation Recurrence and Inflammatory Cytokines Post Ablation – The Steroid AF Study

BACKGROUND: Use of corticosteroids before and after atrial fibrillation (AF) ablation can decrease acute inflammation and reduce AF recurrence. PURPOSE: To assess the efficacy of oral prednisone in improving the outcomes of pulmonary vein isolation with radiofrequency ablation and its effect on inflammatory cytokines. METHODS: A total of 60 patients with paroxysmal AF undergoing radiofrequency ablation were randomized (1:1) to receive either 3 doses of 60 mg Q Day of Oral Prednisone or a placebo. Inflammatory cytokines level (TNF-α, IL-1, IL6, IL-8) were measured at baseline, prior to ablation, immediately after ablation, and 24 hour post ablation. Patients underwent 30 day event monitoring at 3 months, 6 months and 12 months post procedure. RESULTS: Immediate post ablation levels of inflammatory cytokines were lower in the steroid group when compared to the placebo group; IL-6: 9.0 7 vs 15.8 13 p=0.031; IL-8: 10.5 9 vs 15.3 8; p=0.047 respectively. Acute PV reconnection rates during the procedure (7/23% vs 10/36%; p = 0.39), and RF ablation time (5113 vs 5611 min, p = 0.11) trended to be lower in the placebo group than the steroid group. There was no difference in the incidence of early recurrence of AF during the blanking period and freedom from AF off AAD at 12 months between both groups (5/17% vs 8/27%; p = 0.347 and 21/70% vs 18/60%; p=0.417 in placebo and steroid groups respectively). CONCLUSION: Although oral corticosteroids have significant effect in lowering certain cytokines, it did not impact the clinical outcomes of AF ablation.

Credits: Sandia Iskandar, Madhu Reddy, Mohit Turagam, Muhammad R. Afzal, Johnson Rajasingh, Moustapha Atoui, Madhav Lavu, Donita Atkins, Sudha Bommana, Linda Umbarger, Misty Jaeger, Rhea Pimentel, Raghuveer Dendi, Martin Emert, Luigi Di Biase, Andrea Natale, Dhanunjaya Lakkireddy

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