Prevention of Atrial Fibrillation Recurrence With Corticosteroids After Radiofrequency Catheter Ablation

• Published in: Journal of the American College of Cardiology 2010-10, Vol.56 (18), p.1463-1472
• Main Authors: Koyama, Takashi, MD, Tada, Hiroshi, MD, Sekiguchi, Yukio, MD, Arimoto, Takanori, MD, Yamasaki, Hiro, MD, Kuroki, Kenji, MD, Machino, Takeshi, MD, Tajiri, Kazuko, MD, Zhu, Xu Dong, MD, Kanemoto-Igarashi, Miyako, MD, Sugiyasu, Aiko, MD, Kuga, Keisuke, MD, Nakata, Yoshio, PhD, Aonuma, Kazutaka, MD
• Format: Article
• Language: English
• Subjects: ablation; atrial fibrillation; Cardiovascular; corticosteroid; inflammatory response; Internal Medicine; recurrence
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.04.057

Objectives We sought to clarify the efficacy of corticosteroid therapy for preventing atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Background The inflammatory process may cause acute AF recurrence after PVI. However, no studies have examined the relationship between corticosteroid administration and AF recurrence after PVI. Methods A total of 125 patients with paroxysmal AF were randomized to receive either corticosteroids (corticosteroid group) or a placebo (placebo group). In the corticosteroid group, intravenous hydrocortisone (2 mg/kg) was given the day of the procedure, and oral prednisolone (0.5 mg/kg/day) was administered for 3 days after the PVI. The body temperature and high-sensitivity C-reactive protein level were measured before and on each of the first 3 days after ablation. Results The prevalence of immediate AF recurrence (≤3 days after the PVI) was significantly lower in the corticosteroid group (7%) than in the placebo group (31%). The maximum body temperature and C-reactive protein during the initial 3 days after ablation and the increase in the body temperature and C-reactive protein level from baseline were significantly lower in the corticosteroid group than in the placebo group. Corticosteroid treatment did not decrease AF recurrences between 4 and 30 days after ablation. The AF-free rate at 14 months post-ablation was greater in the corticosteroid group (85%) than in the placebo group (71%, p = 0.032 by the log-rank test). Conclusions 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.