Abstract:
Background: Inflammation is integral in the pathogenesis and
propagation of atrial fibrillation (AF). Peri-ablation administration of
steroids has been shown to significantly reduce AF recurrence at 3
months. We sought to determine the effect of intraoperative
dexamethasone on early recurrence at both 3 months and 12 months
post-ablation.
Objective : To evaluate the effect of single-dose intravenous
dexamethasone on AF recurrence following radiofrequency catheter
ablation.
Methods: A cohort of 94 adult patients (>18 years)
underwent catheter ablation at Mayo Clinic Rochester from January to
March 2019. Only first-time ablation patients were included, with all
re-do ablations excluded to minimize heterogeneity. Administration of
intraoperative dexamethasone 4 mg or 8 mg was determined by chart review
from the procedure. At our institution, intraoperative intravenous
steroids are administered for postoperative nausea and vomiting (PONV)
prophylaxis at the discretion of the anesthesiologist. AF recurrence was
determined by ECG or cardiac monitoring at less than 3 months or between
3 months and 1 year with an in-person follow-up visit.
Results: A total of 36.2% of patients received intravenous
dexamethasone compared to 63.8% who did not (providing a 2:1 comparison
group). The incidence of documented AF or flutter lasting greater than
30 seconds was 20.6% in the dexamethasone group versus 21.7% in the
non-dexamethasone group, p value 1.00. AF or atrial flutter recurrence
from 3 months to 1 year was 20.6% in the dexamethasone group compared
to 21.7% in the non-dexamethasone group, p value 1.00.
Conclusion: These data suggest that intraoperative intravenous
dexamethasone administered during AF ablation for postoperative nausea
and vomiting prophylaxis does not have a significant effect on AF
recurrence rates.
Key words: atrial fibrillation, ablation, steroids, outcomes,
recurrence