Peri-procedural Corticosteroid Use in Improving Outcomes Following Atrial Fibrillation Ablation: Back to Square One?

Abstract

Bilateral pulmonary vein (PV) isolation by catheter ablation has become an established therapy for highly symptomatic, drug refractory, paroxysmal atrial fibrillation (AF) (1, 2). The efficacy of pulmonary vein isolation has improved over the years through refinement of procedural technique as well as improved ablation technology involving irrigated ablation, contact force sensing, and “single shot” ablation techniques such as cryo, laser, and multielectrode ablation catheters(1, 3-5). However, durable pulmonary vein isolation has remained a significant challenge with increasing rates of pulmonary vein reconnection noted during long-term follow-up (6, 7). Similarly, acute reconnections as well as early recurrences during the blanking period have been associated with reduced freedom from AF during follow-up(8). With radiofrequency (RF) ablation, acute inflammation from the ablation lesions itself have been thought to have a major role in AF recurrences during the immediate peri-procedural period (9).