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Published on: August 25, 2022
IntravenousCorticosteroid Use Is Associated With Reduced Early Recurrence of Atrial Fibrillation Immediately
Nitesh A Sood1, Guru M Krishnan1, Craig I Coleman1
1University of Connecticut Schools of Medicine and Pharmacy Farmington and Storrs, CT and Department of Cardiology and Drug Information, Hartford Hospital, Hartford, CT.
Insights
Post-ablation inflammation may cause early atrial fibrillation recurrence. Intravenous corticosteroids significantly reduced early recurrence rates after radiofrequency catheter ablation for atrial fibrillation, showing a dose-dependent effect.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Early recurrence of atrial fibrillation (ERAF) affects up to 40% of patients post-radiofrequency catheter ablation (RFCA).
- Inflammation is a suspected contributor to ERAF, but short-term postoperative corticosteroid use has been understudied.
- ERAF increases hospital stay, medication needs, and potentially future AF risk.
Purpose of the Study:
- To investigate the efficacy of short-term intravenous corticosteroid administration in reducing ERAF after RFCA.
- To determine if corticosteroid use impacts ERAF rates in patients undergoing RFCA for atrial fibrillation.
Main Methods:
- A case-control study involving 68 patients undergoing RFCA for atrial fibrillation.
- Treatment group received intravenous corticosteroids post-ablation for 48 hours; control group did not.
- Multivariable logistic regression analyzed the impact of corticosteroids on ERAF, defined as AF > 10 minutes during hospitalization.
Main Results:
- The overall ERAF rate was 23.5%.
- Intravenous corticosteroid administration was associated with an 82% reduction in the odds of ERAF (aOR, 0.18; 95% CI, 0.04-0.78).
- A dose-response relationship was observed, with each mg-equivalent of dexamethasone reducing ERAF odds by 17% (aOR, 0.83; 95% CI, 0.73-0.96).
Conclusions:
- Intravenous corticosteroid use significantly reduced the odds of developing early recurrence of atrial fibrillation post-RFCA.
- A dose-dependent reduction in ERAF was observed with increasing corticosteroid dosage.
- Corticosteroids represent a potential therapeutic strategy to mitigate ERAF following RFCA.
Abstract:
Background: Early recurrence of atrial fibrillation (ERAF) occurs in up to 40% of patients after radiofrequency catheter ablation for atrial fibrillation (RFCA), increasing hospital stay, need for anti-arrhythmic medications (AADs) and cardioversion, and, possibly, the risk of future AF. It has been postulated that inflammation plays a key role in developing ERAF. Short term postoperative use of corticosteroids to reduce ERAF post-RFCA has not been vigorously studied. Methods: This was a case-control study of consecutive patients undergoing RFCA for the management of AF at a single-institution. RFCA was performed by a single operator from October 2005 through July 2009. Patients receiving intravenous corticosteroids immediately following the ablation and for 48 hours (6 doses) constituted the treatment group. Controls received no intravenous corticosteroids during their hospitalization. All other management strategies were similar between the 2 groups, including the administration of AADs post- operatively. 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 dexamethasone mean dose 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.
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