Background: It has been postulated that inflammation plays a key role in developing early recurrence of atrial fibrillation (ERAF) following radiofrequency catheter ablation (RFCA) for the management of symptomatic drug refractory atrial fibrillation (AF). ERAF increases hospital stay, need for anti-arrhythmic medications and cardioversion, and may increase the risk of future AF. Short term use of corticosteroids to reduce ERAF post-RFCA has not been previously reported.
Methods: This was a retrospective cohort studyof consecutive patients undergoing RFCA for the management of AF at a single-institution performed by a single operator from October 2005 through July 2009. Patients receiving intravenous corticosteroids constituted the treatment group. Controls received no intravenous corticosteroids during there hospitalization. All other management strategies were similar between the 2 groups. All patients had continuous electrocardiographic monitoring throughout their hospitalization. Multivariable logistic regression analysis was used to determine the impact of intravenous corticosteroids on ERAF (defined as any AF>10 minutes during hospitalization).
Results: A total of 68 patients undergoing RFCA for the management of AF were included in this analysis. The overall ERAF rate, irrespective of intravenous corticosteroid use, was 23.5%. The administration of intravenous corticosteroids (n=37; mean±SD dose in dexamethasone equivalents: 11.9±4.6 mg/day; range 4-16 mg/day) was associated with an 82% reduction in patients’ odds of ERAF (adjusted odds ratio; 0.18, 95% confidence interval [CI] 0.04 to 0.78) compared with those who did not receive corticosteroids (n=31). A dose-response effect was also observed, with a 17% reduction in ERAF odds for each dexamethasone mg-equivalent administered (adjusted odds ratio; 0.83, 95%CI 0.73 to 0.96).
Conclusions: The use of intravenous corticosteroids was associated with a dose-dependent reduction in the odds of developing ERAF after RFCA for the management of AF.
Credits: Nitesh A. Sood, MD; Guru M. Krishnan, MD; Craig. I. Coleman, PharmD; Jeffrey Kluger, MD; Moise Anglade, MD; Christopher A. Clyne, MD.