Preprocedural corticosteroid treatment effect on early atrial fibrillation recurrence after cryoballoon ablation

Background: Early atrial fibrillation (AF) recurrences after pulmonary-vein-isolation (PVI) catheter ablation, using either radiofrequency or cryoballoon-ablation, are attributed to an increased periprocedural inflammatory response. Corticosteroid treatment attenuates early postprocedural AF-recurrence. Nevertheless, the impact of corticosteroids on early AF-recurrence after cryoballoon-PVI remains unclear.

Methods: We conducted a retrospective study among consecutive patients treated with periprocedural corticosteroid therapy before cryoballoon-PVI for contrast hypersensitivity prophylaxis between January 1st, 2013 and December 31st, 2018, in a large tertiary medical center in Burlington, Massachusetts, USA. Included corticosteroids were: methylprednisolone, hydrocortisone, prednisolone, and dexamethasone. Cases were matched with controls from the same period in a 2:1 manner based on sex, age, left ventricular ejection fraction, and atrial fibrillation persistency status.

Results: Twenty patients were pretreated with corticosteroids during the study period, to whom forty controls were matched. Patients (45% females, 80% paroxysmal-AF) had a mean age of 63 ±9 years and a median ejection-fraction of 60% (interquartile-range:55-60). Antiarrhythmic treatment was fewer in the steroid-treatment group (25% vs. 62.5% in the control group,p=0.006). The steroid-treatment group had longer procedure-time (128 minutes vs. 100,p=0.008), fluoroscopy-time (34.4 vs. 26.8 minutes in the control group, p=0.028), and cryoablation-time durations (28 vs. 19 minutes in the control group,p=0.019). Eleven patients (37.5%) from the control group and six patients (30%) from the treatment group underwent concomitant radiofrequency ablation. Early AF-recurrence was similar between groups after three days (0% in the steroid-treatment group vs. 2.5% in the control group), after one month (15% in steroid-treatment-group vs. 22.5% in the control group), and after three months (20% in steroid-treatment group and 12.5% in the control group), p>0.1 for all. Longer concomitant radiofrequency-ablation time was associated with increased AF-recurrence (p=0.011).

Conclusions: Periprocedural steroid preparation does not reduce early AF recurrence after cryoballoon-PVI. Longer concomitant radiofrequency ablation may result in a higher risk for early-AF-recurrence.