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Single-Dose Intraprocedural Steroid Administration Does Not Impact Early Atrial Fibrillation Recurrence
Kolade M Agboola1,2, Michael Dietrich1,2, Roshan Karki1,2
1Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Insights
Single-dose intravenous dexamethasone given during atrial fibrillation ablation did not significantly impact recurrence rates. This study found no clear benefit for using dexamethasone for postoperative nausea and vomiting prophylaxis in these patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Radiofrequency catheter ablation is a standard treatment for AF.
- Postoperative nausea and vomiting (PONV) is a common complication after ablation procedures.
Purpose of the Study:
- To evaluate the effect of single-dose intravenous dexamethasone on AF recurrence after radiofrequency catheter ablation.
- To determine if dexamethasone, used for PONV prophylaxis, influences AF recurrence rates.
Main Methods:
- A cohort of 84 adult patients undergoing first-time AF ablation were analyzed.
- Patients received either intravenous dexamethasone (4mg or 8mg) or no steroid for PONV prophylaxis.
- AF recurrence was monitored via ECG and cardiac monitoring within 12 months post-ablation.
Main Results:
- 36.9% of patients received dexamethasone; 63.1% did not.
- AF or atrial flutter recurrence within 3 months was 29.0% in the dexamethasone group vs. 24.5% in the non-dexamethasone group (p=0.80).
- Recurrence between 3-12 months was 3.2% in the dexamethasone group vs. 9.4% in the non-dexamethasone group (p=0.41).
Conclusions:
- Intraoperative intravenous dexamethasone for PONV prophylaxis during AF ablation does not appear to significantly affect AF recurrence rates.
- Further research may be needed to confirm these findings.
- Dexamethasone's role in AF ablation patient management warrants careful consideration.
Purpose:
To evaluate the effect of single-dose intravenous dexamethasone on atrial fibrillation (AF) recurrence following radiofrequency catheter ablation.
Methods:
A cohort of 84 adult patients (> 18 years) underwent catheter ablation at Mayo Clinic Rochester from January to March 2019. Only first-time ablation patients were included, with all re-do ablations excluded to minimize heterogeneity. Administration of intraoperative dexamethasone 4 mg or 8 mg was determined by chart review from the procedure. At our institution, intraoperative intravenous steroids are administered for postoperative nausea and vomiting (PONV) prophylaxis at the discretion of the anesthesiologist. AF recurrence was determined by ECG or cardiac monitoring within 3 months or between 3 and 12 months post-ablation with an in-person follow-up visit.
Results:
A total of 31 (36.9%) patients received intravenous dexamethasone compared to 54 (63.1%) who did not (approximating a 2:1 comparison group). The incidence of documented AF or atrial flutter, lasting greater than 30 s, within the first 3 months post-ablation was 29.0% in the dexamethasone group versus 24.5% in the non-dexamethasone group (p value 0.80). AF or atrial flutter recurrence at 3-12 months post-ablation was 3.2% in the dexamethasone group compared to 9.4% in the non-dexamethasone group (p value 0.41).
Conclusion:
These data suggest that intraoperative intravenous dexamethasone administered during AF ablation for postoperative nausea and vomiting prophylaxis may not have a significant effect on AF recurrence rates.
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