Yonsei Med J.  2015 Mar;56(2):324-331. 10.3349/ymj.2015.56.2.324.

Comparison of Two Different Doses of Single Bolus Steroid Injection to Prevent Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation

• Kim DR
• Won H
• Uhm JS
• Kim JY
• Sung JH
• Pak HN
• Lee MH
• Joung B

• KMID: 2070006
• DOI: http://doi.org/10.3349/ymj.2015.56.2.324

Abstract

PURPOSE
Steroids may play a role in preventing the early recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). However, optimal doses and route of steroid delivery have not yet been determined. This study evaluated the effect of two different doses of a single bolus injection of steroids on AF recurrence after RFCA.
MATERIALS AND METHODS
Of 448 consecutive AF patients who underwent RFCA, a single steroid bolus was injected into 291 patients. A low-dose steroid group (n=113) received 100 mg of hydrocortisone and a moderate-dose steroid group (n=174) received 125 mg of methylprednisolone. We used propensity-score matching to select patients as follows: control (n=95), low-dose (n=95), and moderate-dose steroid groups (n=97).
RESULTS
Pericarditis developed in 1 (1.1%) control patient, 2 (2.1%) low-dose patients and 0 moderate-dose patients. Maximum body temperature and C-reactive protein were significantly decreased in the moderate-dose steroid group compared to the other groups (p<0.01). The number of patients of early AF recurrence (< or =3 months) did not differ among three groups. Early recurrence was 24 (25%) in the control, 24 (25%) in the low-dose and 25 (26%) in the medium-dose groups (p=0.99). Compared with control group, low-dose or moderate-dose steroid treatment did not effectively decrease mid-term (3-12 months) AF recurrence [22 (23%) vs. 23 (24%) vs. 18 (19%); p=0.12].
CONCLUSION
A single injection of moderate-dose steroid decreased inflammation. However, single bolus injections of low-dose or moderate-dose steroids were not effective in preventing immediate, early or midterm AF recurrence after RFCA.

Keyword

Atrial fibrillation; ablation; steroid

MeSH Terms

Adult
Aged
Anti-Inflammatory Agents/*administration & dosage/adverse effects
Atrial Fibrillation/physiopathology/*prevention & control
C-Reactive Protein/drug effects
*Catheter Ablation
Female
Follow-Up Studies
Humans
Hydrocortisone/*administration & dosage/adverse effects
Male
Middle Aged
Recurrence
Secondary Prevention
Time Factors
Treatment Outcome
Anti-Inflammatory Agents
C-Reactive Protein
Hydrocortisone

Figure

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  Fig. 1 Flow diagram describing outcome of RFCAs. AF, atrial fibrillation; RFCA, radiofrequency catheter ablation.

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  Fig. 2 Kaplan-Meier survival curves for AF recurrence. No difference was seen in cumulative rates of absence of late AF recurrence among control, low-dose, and moderate-dose patients (p=0.11 by log-rank test). AF, atrial fibrillation.

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