title: Corticosteroid use during pulmonary vein isolation is associated with a higher prevalence of dormant pulmonary vein conduction.
abstract: BACKGROUND
  Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is associated with PV to left atrium reconduction.
  
  
  OBJECTIVE
  The purpose of this study was to prospectively determine if the use of intraprocedural corticosteroids to limit the extent of tissue edema and/or inflammation alters the prevalence of spontaneous and adenosine-induced acute PV reconnection after PVI.
  
  
  METHODS
  Prior to wide circumferential PVI, 45 patients received a single intravenous (IV) bolus of hydrocortisone 250 mg immediately after transseptal access (steroid group). Another 45 consecutive patients underwent standard PVI without IV hydrocortisone (nonsteroid group). After PVI, all patients underwent adenosine testing to unmask dormant conduction. Patients were followed at 3, 6, and 12 months.
  
  
  RESULTS
  Dormant conduction was unmasked in a significantly higher proportion of PVs in the steroid group compared with the nonsteroid group (32.8% of PVs [60/183] vs 21.1% of PVs [37/175], P = .03). On multivariate generalized estimating equation analysis, steroid use remained independently associated with dormant PV conduction (P = .03). There was no difference in the segmental distribution of reconnection between the 2 groups. The 1-year freedom from recurrent AF did not differ between groups (P = .37). Radiofrequency time was significantly longer in the steroid group (58 ± 21 minutes vs 48 ± 18 minutes, P <.01), whereas procedure duration and fluoroscopy time were comparable (P = .55 and P = .44, respectively).
  
  
  CONCLUSIONS
  A single bolus of hydrocortisone 250 mg IV prior to PVI results in greater radiofrequency requirements for PVI and a higher prevalence of dormant PV conduction unmasked by adenosine. The utility of these approaches requires evaluation in a long-term prospective randomized study.
authors.affiliation: Electrophysiology Service at the Montreal Heart Institute and Department of Medicine, Université de Montréal, Montreal, Canada,; Department of Medicine, The University of British Columbia, Vancouver, Canada. Electronic address: Jason.guy.andrade@umontreal.ca.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Stanley
authors.initials: S
authors.lastname: Nattel
authors.forename: Agustin
authors.initials: A
authors.lastname: Vanella
authors.forename: Léna
authors.initials: L
authors.lastname: Rivard
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.forename: Katia
authors.initials: K
authors.lastname: Dyrda
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Blandine
authors.initials: B
authors.lastname: Mondesert
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
mesh_terms: D000241:Adenosine / Q000627:therapeutic use; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation; D004553:Electric Conductivity; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D006854:Hydrocortisone; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology*; D012008:Recurrence
chemical_list: D000889:Anti-Arrhythmia Agents; D000241:Adenosine; D006854:Hydrocortisone
keywords: AF; AFL; AT; Ablation; Atrial fibrillation; GEE; Hydrocortisone; INR; IQR; IV; Inflammation; LA; PV; PVI; Pulmonary vein; RF; RFCA; Steroids; atrial fibrillation; atrial flutter; atrial tachycardia; generalized estimating equation; international normalized ratio; interquartile range; intravenous; left atrium; pulmonary vein; pulmonary vein isolation; radiofrequency; radiofrequency catheter ablation