Prevention of Atrial Fibrillation Recurrence With Corticosteroids After Radiofrequency Catheter Ablation

Koyama, Takashi; Tada, Hiroshi; Sekiguchi, Yukio; Arimoto, Takanori; Yamasaki, Hiro; Kuroki, Kenji; Machino, Takeshi; Tajiri, Kazuko; Zhu, Xu; Kanemoto-Igarashi, Miyako; Sugiyasu, Aiko; Kuga, Keisuke; Nakata, Yoshio; Aonuma, Kazutaka

doi:10.1016/j.jacc.2010.04.057

Cited by 150 publications

(105 citation statements)

References 25 publications

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“…981,982 The prevalence of immediate AF recurrences (≤3 days after PVI) was significantly lower in the corticosteroid group compared with the placebo group (7% vs 31%). However, few investigators routinely administer steroids during or following AF ablation.…”

Section: Early Reablationmentioning

confidence: 91%

“…One study examined this hypothesis in a population of 125 patients undergoing PV ablation for symptomatic PAF. 981 Corticosteroid therapy resulted in a significant reduction in the early AF recurrence rate (27% vs 49% at 1 month with corticosteroids vs placebo, respectively), which was driven by a marked reduction in the immediate recurrence rate (7% vs 31% within 72 hours, respectively). Interestingly, despite the lack of difference in the rate of recurrence between 3 and 30 days (20% vs 18% in the corticosteroid and placebo groups, respectively), the long-term freedom from AF without any AAD was significantly higher in the corticosteroid group (85% vs 71% freedom from AF at 14 months, respectively).…”

Section: Early Recurrence After Ablationmentioning

confidence: 92%

See 1 more Smart Citation

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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Section: Early Reablationmentioning

confidence: 91%

Section: Early Recurrence After Ablationmentioning

confidence: 92%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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“…The early occurrence of atrial tachycardia (during the first 3 months) could be mediated by atrial inflammation, while subsequent maturation of ablative lesions in the first weeks after the procedure could lead to spontaneous disappearance of tachycardia in 39%-50% of patients [3,120,201]. The early occurrence of atrial arrhythmias after AF ablation could be reduced with antiarrhythmic or anti-inflammatory drugs, and in case of persistent forms, elective cardioversion should be performed [57][58][59]. Due to longer atrial cycle length, atrial tachycardia is usually followed by faster ventricular response and more severe symptoms than pre-procedural AF [194].…”

Section: Phrenic Nerve Injurymentioning

confidence: 99%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

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“…We defined immediate recurrence as any episode of AF or atrial tachycardia (AT) of at least 30 s that occurred within 2 days after AF ablation, early recurrence between 3 and 30 days and late recurrence after 31 days, respectively. 11, 12 Three patients in the control group who developed pericarditis after RFCA were excluded from the analysis of recurrence because they were treated with higher doses of corticosteroids.…”

Section: Follow-upmentioning

confidence: 99%

“…Recently, transient use of corticosteroids shortly after AF ablation was reported to be effective and safe for preventing AF recurrence during the mid-term follow-up period after pulmonary vein isolation (PVI). 12 There is increased risk of hyperglycemia, postoperative pneumonia, urinary tract infections, and gastrointestinal bleeding after steroid therapy. In addition, high-dose steroids may cause ventricular proarrhythmia and even promote AF.…”

mentioning

confidence: 99%

Effect of a Single Bolus Injection of Low-Dose Hydrocortisone for Prevention of Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation

Won

Kim

Shim

et al. 2013

Circ J

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Background:The transient use of corticosteroid shortly after atrial fibrillation (AF) ablation might prevent immediate and mid-term AF recurrence; however, the effective dosage for preventing AF recurrence has not been determined. In this study, we evaluated whether low-dose hydrocortisone is effective for the prevention of AF recurrence after radiofrequency catheter ablation (RFCA). Methods and Results:We enrolled 89 AF patients (70 males, 55.8±10.9 years) who underwent RF ablation and were treated with single bolus injection of 100 mg hydrocorticosteroid (corticosteroid group). For the control group, we enrolled 120 sex- and age-matched AF patients (94 males, 55.4±10.5 years). Pericarditis occurred in 3 (2.5%) and 1 (1.1%) patients in the control and corticosteroid groups, respectively. The number of patients with immediate AF recurrence (≤2 days) was 17 (14.5%) and 11 (12.4%) in the control and steroid groups, respectively (P=0.687). Treatment with low-dose steroid did not decrease early (3-30 days) AF recurrence (13 [ There was no difference in cumulative survival free of late AF recurrence between the corticosteroid and control groups (P=0.57 by log-rank test). White blood cell count, C-reactive protein concentration and maximum body temperature also were unchanged by low-dose steroid. Conclusions Methods PatientsThis study included 89 patients with drug-resistant AF who underwent RF ablation and were treated with corticosteroid at Yonsei University Hospital (Seoul, Korea) from July 2007 to December 2010. All patients were newly enrolled in this study, and none had a history of ablation. For the control group, we enrolled 120 sex-and age-matched AF patients who had undergone RF ablation of AF during the same period. Both groups included patients with only first-time ablation. All patients had symptomatic, paroxysmal or persistent AF. The selection of patients to be given steroid depended on the operators. A physician (B.J.) had the strategy of giving corticosteroid after catheter ablation, whereas the other physicians (M.-H.L. and H.-N.P.) did not give steroid. Patients were randomly assigned to operators without this information. However, the ablation protocol was the same for all the operators. Paroxysmal AF was defined as AF episodes that spontaneously terminated and lasted for >30 s and <7 days during treatment with antiarrhythmic drugs (AADs). Persistent AF was defined as AF episodes that either lasted longer than 7 days or that required termination by cardioversion, either with AADs or by direct current cardioversion. All AADs were discontinued 5 half-lives before the ablation procedure, and other drugs were administered throughout the duration of the study period.The study protocol was approved by the Institutional Review Board of Severance Cardiovascular Hospital, Seoul, Korea and complied with the Declaration of Helsinki.

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Prevention of Atrial Fibrillation Recurrence With Corticosteroids After Radiofrequency Catheter Ablation

Abstract: Transient use of small amounts of corticosteroids shortly after AF ablation may be effective and safe for preventing not only immediate AF recurrences but also AF recurrences during the mid-term follow-up period after PVI.

Cited by 150 publications

References 25 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Catheter Ablation of Lone Atrial Fibrillation

Effect of a Single Bolus Injection of Low-Dose Hydrocortisone for Prevention of Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation

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