Key result
Steroids are associated with ~47% lower odds of early AF recurrence after catheter ablation.
Why the study?
Does steroid use prevent the recurrence of atrial fibrillation in patients undergoing radiofrequency catheter ablation?
Meta-Analysis (n=992)
Does steroid use prevent the recurrence of atrial fibrillation in patients undergoing radiofrequency catheter ablation?
Odds Ratio: 0.53 (95% CI 0.31–0.9)
p-value: p=0.02
Peri-procedural steroid administration appears to reduce the intermediate-term risk of atrial fibrillation recurrence (at 3 and 12-14 months) after catheter ablation, likely by mitigating early post-ablation inflammatory responses.
May reduce intermediate-term AF recurrence after ablation; leaves open need for dedicated RCTs before practice change.
Previous studies have reported that steroids may reduce the risk of atrial fibrillation (AF) recurrence after catheter ablation, but data regarding this issue have been controversial. Therefore, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies to ascertain the association of steroids and AF recurrence after ablation. PubMed, Embase, and Cochrane online databases were searched from inception to December 2017. The primary outcome of the meta-analysis was short-term or long-term AF recurrence following a single ablation procedure with or without the use of steroids. Both fixed- and random-effects models were used to calculate the overall effect estimates. Eight studies (four RCTs and four observational studies), with a total 992 patients, were included in the present study. Our meta-analysis shows that steroid use was associated with reduced AF occurrence at 3 months (odd ratio (OR) = 0.53, 95% confidence interval (CI) = 0.31–0.90, P=0.02) and 12–14 months (OR = 0.67, 95% CI = 0.47–0.95, P=0.02) after radiofrequency (RF) catheter ablation (RFCA). No clear benefit was observed for AF recurrence at 2–3 days, 1 or 24 months of follow-up. Steroid use was associated with decreased risk of early AF recurrence 3 and 12–14 months after ablation. No clear relationship was observed for 2–3 days, 1 and 24 months of follow-up and further data are needed to clarify these results.
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Lei et al. (2018) conducted a meta-analysis in Atrial fibrillation (drug-refractory symptomatic paroxysmal or persistent) undergoing radiofrequency catheter ablation (n=992). Steroids (hydrocortisone, dexamethasone, prednisone, methylprednisolone) vs. Control (without steroids) was evaluated on Atrial fibrillation recurrence at 3 months post-ablation (OR 0.53, 95% CI 0.31-0.90, p=0.02). Steroid use was associated with a significantly decreased risk of early atrial fibrillation recurrence at 3 months (OR 0.53) and 12-14 months (OR 0.67) after radiofrequency catheter ablation.
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