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).

Conclusion: 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.

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.