Abstract 2756: Prevention of Atrial Fibrillation Recurrence after Radiofrequency Catheter Procedure of Pulmonary Vein Isolation by Corticosteroids

Abstract

Background: Catheter based radiofrequency pulmonary vein isolation (PVI) has been shown to be an effective therapeutic option for controlling drug-refractory atrial fibrillation (AF); however, the recurrence of AF has become one of the major problems after procedure. Although the underlying mechanism of the AF recurrence is not well evaluated, previous reports indicated that inflammatory process could be associated with the onset of AF and the use of intravenous hydrocortisone reduced the incidence of AF after coronary artery bypass surgery. We therefore prospectively evaluated the efficacy of the hydrocortisone for the prevention of AF recurrence. Methods and Results: This study included consecutive 150 patients with drug-refractory paroxysmal AF. Patients were randomized to receive either hydrocortisone or matching placebos as follows: intravenous hydrocortisone (dose of 2mg/kg) was used in the day of operation, and oral hydrocortisone was administered (dose of 0.6mg/kg/day) for 3 days after PVI. Patients with non-PV-foci AF were excluded in this study (Control group; 4 patients, Hydrocortisone group; 6 patients). Various biophysical data were closely investigated between control group (n=71) and hydrocortisone group (n=69). Rate of total AF recurrence and immediate AF recurrence (recurrence of AF within 3 days after PVI) was significantly lower in hydrocortisone group than placebo group (total AF recurrence; 27.0% vs 46.1%, immediate AF recurrence; 6.7% vs 29.5%, p<0.01). Number of patients who underwent second PVI (8.3% vs 23.1%, p<0.01), rise of body temperature after the procedure (0.675°C vs 1.633°C, p=0.005), any sign of pericariditis (0% vs 6.4%, p<0.01), high sensitive CRP level after the procedure (1.17mg/dl vs 2.09mg/dl, P=0.015) and the number of patients using antiarrhythmics (classIb, classIII) after the procedure (classIb; 0% vs 6.4%, classIII; 6.7% vs 26.9%, p<0.01) were also significantly lower in hydrocortisone group than in placebo group. Conclusion: Transient use of hydrocortisone immediately after PVI can be one of the therapeutic options for the prevention of acute AF recurrence after PVI to avoid second procedure and/or the additional antiarrhythmic drug therapy.