Prevention of atrial fibrillation recurrence with corticosteroids after radiofrequency catheter ablation: a randomized controlled trial.
OBJECTIVE
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.
Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan. tkoyama-tym@umin.ac.jp
Takashi
T
Koyama
Hiroshi
H
Tada
Yukio
Y
Sekiguchi
Takanori
T
Arimoto
Hiro
H
Yamasaki
Kenji
K
Kuroki
Takeshi
T
Machino
Kazuko
K
Tajiri
Xu Dong
XD
Zhu
Miyako
M
Kanemoto-Igarashi
Aiko
A
Sugiyasu
Keisuke
K
Kuga
Yoshio
Y
Nakata
Kazutaka
K
Aonuma
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D017115:Catheter Ablation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones