title: Influence of steroid therapy on the incidence of pericarditis and atrial fibrillation after percutaneous epicardial mapping and ablation for ventricular tachycardia.
abstract: BACKGROUND
  This study evaluates the influence of 3 therapeutic approaches on the incidence of pericarditis and atrial fibrillation (AF) after percutaneous epicardial mapping and ablation for ventricular tachycardia.
  
  
  RESULTS
  Eighty-five consecutive procedures (2006-2011) were retrospectively reviewed. After the first 17 procedures (20.0%), no steroids were administered. For the subsequent 30 procedures (35.3%), systemic steroids were administered intravenously or orally, whereas the last 38 procedures (44.7%) were followed by intrapericardial steroid injection. Compared with no steroids, the incidence of pericarditic chest pain was significantly reduced by intrapericardial steroids (58.8% versus 21.1%; P=0.006) but not by intravenous or oral steroids (58.8% versus 43.4%; P=0.31). There was no significant difference in the incidence of pericarditic ECG with steroids (36.8%, 30.0%, and 41.2% for intrapericardial, intravenous or oral, and none, respectively). There was a nonsignificant reduced incidence of chest pain with ECG changes with steroids (13.2%, 10.0%, and 29.4% for intrapericardial, intravenous or oral, and none, respectively). Radiofrequency applications (65.9% of procedures) did not affect the incidence of pericarditic ECG changes, pericarditic chest pain, or pericarditis (all P>0.05). In 7 (8.3%) patients with no prior history of AF, AF was documented a median 36 hours after procedure. Patients with pericarditic ECG tended to be at greater risk of AF (16.7 versus 3.6%; P=0.091).
  
  
  CONCLUSIONS
  There is a high incidence of pericarditic chest pain and ECG changes after epicardial ventricular tachycardia mapping and ablation. Pericarditic chest pain is significantly decreased by intrapericardial steroids. Procedure-related AF is relatively frequent and tends to occur more commonly with pericarditic ECG changes.
authors: From the Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Katia
authors: K
authors: Dyrda
authors: From the Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Sebastiaan R D
authors: SR
authors: Piers
authors: From the Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Carine F
authors: CF
authors: van Huls van Taxis
authors: From the Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Martin J
authors: MJ
authors: Schalij
authors: From the Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. K.Zeppenfeld@lumc.nl.
authors: Katja
authors: K
authors: Zeppenfeld
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000009:adverse effects*; D002637:Chest Pain / Q000453:epidemiology / Q000517:prevention & control; D004562:Electrocardiography; D056149:Epicardial Mapping / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage*; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids
keywords: pericarditis; tachycardia, ventricular