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Single dose of IV steroids following ablation may reduce severe arrhythmias
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Heart Rhythm Society 31st Annual Scientific Sessions
DENVER — A single dose of IV methylprednisolone after AF ablation showed a trend toward a significant decrease in severe arrhythmias in the six weeks following surgery, according to a speaker here, who suggested that routine steroid use post ablation should be considered as a treatment option.
“Catheter ablation for symptomatic AF is becoming increasingly prevalent,” Daniel P. Melby, MD, of the Minneapolis Heart Institute said, adding that there are few interventions currently available.
Because about 50% of early arrhythmias spontaneously dissipate over time and are not due to procedural failure, Melby and colleagues hypothesized that acute procedure-related inflammation may be a possible mechanism.
To determine the effect of post-procedural steroids as a preventive measure, the researchers randomly assigned patients who underwent radiofrequency ablation for AF at Abbott Northwestern Hospital in Minneapolis to either 100 mg IV methylprednisolone (n=36) or placebo (n=37). The primary composite endpoint consisted of severe arrhythmia requiring ER visit or hospitalization, prolonged arrhythmia requiring change in medical therapy and symptomatic AF requiring cardioversion.
Results from interim analyses indicated that more placebo patients reached primary endpoints compared with patients assigned to steroid therapy (24% vs. 8.3%; P=0.11), including symptomatic AF requiring cardioversion (16% vs. 0%; P=.025) and arrhythmia requiring change in medical therapy (19.4% vs. 5.4%; P=.085). Self-reported cardiac pain at one day post-procedure was also higher among placebo patients (1.4 vs. 0.9, 0-10 scale; P=.26).
However, despite these findings there were no significant differences in the number of patients in either group who experienced severe arrhythmia requiring ER visit or hospitalization (5.5% vs. 5.4%).
No steroid related major AEs were reported during the course of the trial, according to Melby. Furthermore, no procedural complications, including pericardial effusion, were encountered in either treatment group.
“Based on these findings, the routine use of IV steroid administration post ablation could be considered, and a larger study appears warranted,” Melby said. Future trials may investigate the role of AF biomarkers and whether or not pre-ablation steroid therapy offers additional benefits, he added. – by Nicole Blazek
For more information:
- Melby DP. LBCT II. Presented at: Heart Rhythm Society 31st Annual Scientific Sessions; May 12-15, 2010; Denver.
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