Role of Steroid Therapy in Preventing Recurrence of Atrial Fibrillation After Ablation: A Systematic Review and Meta-Analysis

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia with challenging management due to its potential complications and high recurrence rates. Catheter ablation is a standard treatment option for symptomatic patients, particularly those unresponsive to medical management but has variable success rates. Inflammation plays a critical role in the pathogenesis and persistence of AF. This systematic review aims to study the potential benefits of corticosteroid use in the prevention of AF recurrence after procedures such as catheter ablation, providing a more comprehensive understanding of their role in improving outcomes. Four randomized controlled trials (RCTs) with 824 total participants and four cohort studies with 1128 participants were included for qualitative and quantitative analysis. All RCTs and cohort studies suggest no significant benefit of corticosteroids with ablation in preventing short-term (less than three months) AF recurrence. However, RCTs indicate that corticosteroid use with ablation significantly reduces the recurrence of AF over three months, but such a statistically significant effect is not seen in cohort studies for AF recurrence up to one year. This suggests that there might be some beneficial role of using steroids with ablation procedures in preventing recurrences of AF, but further large-scale studies are warranted for better evidence to support the use of steroids with ablation. Future research should focus on understanding the optimal duration and dosing of corticosteroid treatment to maximize benefits and minimize risks, especially in the immediate post-treatment period where the data currently show less clarity and higher variability. Additionally, further studies should explore the mechanisms through which corticosteroids exert their effects over different durations to better tailor treatment protocols.