Background: Early recurrence of
atrial fibrillation (ERAF) occurs in up to 40% of patients after
radiofrequency catheter ablation for
atrial fibrillation (RFCA), increasing
hospital stay, need for
anti-arrhythmic medications (AADs) and
cardioversion, and, possibly, the risk of future AF. It has been postulated that
inflammation plays a key role in developing ERAF. Short term postoperative use of
corticosteroids to reduce ERAF post-RFCA has not been vigorously studied. Methods: This was a case-control study of consecutive patients undergoing RFCA for the management of AF at a single-institution. RFCA was performed by a single operator from October 2005 through July 2009. Patients receiving intravenous
corticosteroids immediately following the ablation and for 48 hours (6 doses) constituted the treatment group. Controls received no intravenous
corticosteroids during their hospitalization. All other management strategies were similar between the 2 groups, including the administration of AADs post- operatively. All patients had continuous electrocardiographic monitoring throughout their hospitalization. Multivariable logistic regression analysis was used to determine the impact of intravenous
corticosteroids on ERAF defined as any AF>10 minutes during hospitalization. Results: A total of 68 patients undergoing RFCA for the management of AF were included in this analysis. The overall ERAF rate, irrespective of intravenous
corticosteroid use, was 23.5%. The administration of intravenous
corticosteroids (n=37; mean±SD
dexamethasone mean dose 11.9±4.6 mg/day; range 4-16 mg/day) was associated with an 82% reduction in patients' odds of ERAF (adjusted odds ratio; 0.18, 95% confidence interval [CI] 0.04 to 0.78) compared with those who did not receive
corticosteroids (n=31). A dose-response effect was also observed, with
a 17% reduction in ERAF odds for each
dexamethasone mg-equivalent administered (adjusted odds ratio; 0.83, 95%CI 0.73 to 0.96). Conclusions: The use of intravenous
corticosteroids was associated with a dose-dependent reduction in the odds of developing ERAF after RFCA for the management of AF.