Document Detail


Prevention of atrial fibrillation recurrence with corticosteroids after radiofrequency catheter ablation: a randomized controlled trial.
MedLine Citation:
PMID:  20951321     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: 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.
Authors:
Takashi Koyama; Hiroshi Tada; Yukio Sekiguchi; Takanori Arimoto; Hiro Yamasaki; Kenji Kuroki; Takeshi Machino; Kazuko Tajiri; Xu Dong Zhu; Miyako Kanemoto-Igarashi; Aiko Sugiyasu; Keisuke Kuga; Yoshio Nakata; Kazutaka Aonuma
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  56     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-18     Completed Date:  2010-11-02     Revised Date:  2011-05-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1463-72     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan. tkoyama-tym@umin.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use*
Aged
Atrial Fibrillation / drug therapy,  prevention & control*,  surgery
Catheter Ablation*
Double-Blind Method
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prospective Studies
Recurrence / prevention & control
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2010 Oct 26;56(18):1473-5   [PMID:  20951322 ]
J Am Coll Cardiol. 2011 Apr 12;57(15):1638; author reply 1638-9   [PMID:  21474049 ]

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