Comparison of Two Different Doses of Single Bolus Steroid Injection to Prevent Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation
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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 underwentRFCA, a single steroid bolus was injected into 291 patients. A low-dose steroidgroup (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 (≤3 months) did not differ among three groups. Early recurrencewas 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 injectionof moderate-dose steroid decreased inflammation. However, single bolus injectionsof low-dose or moderate-dose steroids were not effective in preventing immediate,early or midterm AF recurrence after RFCA.
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 underwentRFCA, a single steroid bolus was injected into 291 patients. A low-dose steroidgroup (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 (≤3 months) did not differ among three groups. Early recurrencewas 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 injectionof moderate-dose steroid decreased inflammation. However, single bolus injectionsof low-dose or moderate-dose steroids were not effective in preventing immediate,early or midterm AF recurrence after RFCA.
참고문헌 (28)
- Wilke T, "Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients", Europace, 15, pp.486~493 (2013)
- Wang TJ, "Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study", Circulation, 107, pp.2920~2925 (2003)
- 진정연, "The Effect of Ablation for Paroxysmal Atrial Fibrillation on Left Atrial Volume and Function: A One-Year Follow-Up Study", Yonsei Medical Journal, 55(4), pp.895~903 (2014), 연세대학교의과대학[DOI]
- Gerstenfeld EP, "Incidence and location of focal atrial fibrillation triggers in patients undergoing repeat pulmonary vein isolation: implications for ablation strategies", J Cardiovasc Electrophysiol, 14, pp.685~690 (2003)
- Shah DC, "Electrophysiologically guided ablation of the pulmonary veins for the curative treatment of atrial fibrillation", Ann Med, 32, pp.408~416 (2000)
- Gerstenfeld EP, "Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers", J Cardiovasc Electrophysiol, 12, pp.900~908 (2001)
- Oral H, "Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation", J Am Coll Cardiol, 40, pp.100~104 (2002)
- Issac TT, "Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data", J Am Coll Cardiol, 50, pp.2021~2028 (2007)
- Bruins P, "Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia", Circulation, 96, pp.3542~3548 (1997)
- Aviles RJ, "Inflammation as a risk factor for atrial fibrillation", Circulation, 108, pp.3006~3010 (2003)
- McCabe JM, "Protracted CRP elevation after atrial fibrillation ablation", Pacing Clin Electrophysiol, 31, pp.1146~1151 (2008)
- Koyama T, "Prevention of atrial fibrillation recurrence with corticosteroids after radiofrequency catheter ablation: a randomized controlled trial", J Am Coll Cardiol, 56, pp.1463~1472 (2010)
- Chiappini B, "Risk of atrial fibrillation with high-dose corticosteroids", Expert Opin Drug Saf, 5, pp.811~814 (2006)
- Jahangiri M, "Do corticosteroids prevent atrial fibrillation after cardiac surgery?", Nat Clin Pract Cardiovasc Med, 4, pp.592~593 (2007)
- Liakopoulos OJ, "Cardiopulmonary and systemic effects of methylprednisolone in patients undergoing cardiac surgery", Ann Thorac Surg, 84, pp.110~118 (2007)
- Bourbon A, "The effect of methylprednisolone treatment on the cardiopulmonary bypass-induced systemic inflammatory response", Eur J Cardiothorac Surg, 26, pp.932~938 (2004)
- Oral H, "Noninducibility of atrial fibrillation as an end point of left atrial circumferential ablation for paroxysmal atrial fibrillation: a randomized study", Circulation, 110, pp.2797~2801 (2004)
- Calkins H, "2012 HRS", EHRA, Europace, pp.2012, 14[DOI]
- Koyama T, "Comparison of characteristics and significance of immediate versus early versus no recurrence of atrial fibrillation after catheter ablation", Am J Cardiol, 103, pp.1249~1254 (2009)
- Marik PE, "The efficacy and dosage effect of corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a systematic review", J Crit Care, 24, pp.458~463 (2009)
- Ho KM, "Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis", Circulation, 119, pp.1853~1866 (2009)
- Dernellis J, "Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation", Eur Heart J, 25, pp.1100~1107 (2004)
- Nascimento T, "Impact of prophylactic corticosteroids on systemic inflammation after extensive atrial ablation in pigs", Europace, 14, pp.138~145 (2012)
- Baker WL, "Effect of perioperative corticosteroid use on the incidence of postcardiothoracic surgery atrial fibrillation and length of stay", Heart Rhythm, 4, pp.461~468 (2007)
- Morariu AM, "Dexamethasone: benefit and prejudice for patients undergoing on-pump coronary artery bypass grafting: a study on myocardial, pulmonary, renal, intestinal, and hepatic injury", Chest, 128, pp.2677~2687 (2005)
- Chaney MA, "Hemodynamic effects of methylprednisolone in patients undergoing cardiac operation and early extubation", Ann Thorac Surg, 67, pp.1006~1011 (1999)
- Won H, "Effect of a single bolus injection of low-dose hydrocortisone for prevention of atrial fibrillation recurrence after radiofrequency catheter ablation", Circ J, 77, pp.53~59 (2013)
- Minneci PC, "Meta-analysis: the effect of steroids on survival and shock during sepsis depends on the dose", Ann Intern Med, 141, pp.47~56 (2004)