Use of oral steroid and its effects on atrial fibrillation recurrence and inflammatory cytokines post ablation - The steroid af study

Sandia Iskandar, Madhu Reddy, Muhammad R. Afzal, Johnson Rajasingh, Moustapha Atoui, Madhav Lavu, Donita Atkins, Sudha Bommana, Linda Umbarger, Misty Jaeger, Rhea Pimentel, Raghuveer Dendi, Martin Emert, Mohit Turagam, Luigi Di Biase, Andrea Natale, Dhanunjaya Lakkireddy

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Abstract

Use of corticosteroids before and after atrial fibrillation (AF) ablation can decrease acute inflammation and reduce AF recurrence.To assess the efficacy of oral prednisone in improving the outcomes of pulmonary vein isolation with radiofrequency ablation and its effect on inflammatory cytokines, a total of 60 patients with paroxysmal AF undergoing radiofrequency ablation were randomized (1:1) to receive either 3 doses of 60 mg daily of oral prednisone or a placebo. Inflammatory cytokine levels (TNF-α, IL-1, IL6, IL-8) were measured at baseline, prior to ablation, immediately after ablation, and 24 hours post ablation. Patients underwent 30 day event monitoring at 3 months, 6 months and 12 months post procedure. Immediate post ablation levels of inflammatory cytokines were lower in the steroid group when compared to the placebo group; IL-6:9.0 ±7 vs 15.8 ±13 p=0.031; IL-8:10.5 ±9 vs 15.3 ±8; p=0.047 respectively. Acute PV reconnection rates during the procedure (7/23% vs 10/36%; p = 0.39), and RF ablation time (51±13 vs 56±11 min, p = 0.11) trended to be lower in the placebo group than the steroid group. There was no difference in the incidence of early recurrence of AF during the blanking period and freedom from AF off AAD at 12 months between both groups (5/17% vs 8/27%; p = 0.347 and 21/70% vs 18/60%; p=0.417 in placebo and steroid groups respectively). CONCLUSION: Although oral corticosteroids have significant effect in lowering certain cytokines, it did not impact the clinical outcomes of AF ablation.

Original languageEnglish (US)
JournalJournal of Atrial Fibrillation
Volume9
Issue number5
StatePublished - Feb 1 2017

Fingerprint

Atrial Fibrillation
Steroids
Cytokines
Recurrence
Placebos
Prednisone
Interleukin-8
Interleukin-6
Adrenal Cortex Hormones
Pulmonary Veins
Interleukin-1
Inflammation
Incidence

Keywords

  • Ablation
  • Atrial fibrillation
  • Corticosteroid
  • Inflammatory cytokines
  • Interleukin
  • Prednisone
  • Pulmonary vein isolation
  • Recurrence
  • Tumor necrosis factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Iskandar, S., Reddy, M., Afzal, M. R., Rajasingh, J., Atoui, M., Lavu, M., ... Lakkireddy, D. (2017). Use of oral steroid and its effects on atrial fibrillation recurrence and inflammatory cytokines post ablation - The steroid af study. Journal of Atrial Fibrillation, 9(5).

Use of oral steroid and its effects on atrial fibrillation recurrence and inflammatory cytokines post ablation - The steroid af study. / Iskandar, Sandia; Reddy, Madhu; Afzal, Muhammad R.; Rajasingh, Johnson; Atoui, Moustapha; Lavu, Madhav; Atkins, Donita; Bommana, Sudha; Umbarger, Linda; Jaeger, Misty; Pimentel, Rhea; Dendi, Raghuveer; Emert, Martin; Turagam, Mohit; Di Biase, Luigi; Natale, Andrea; Lakkireddy, Dhanunjaya.

In: Journal of Atrial Fibrillation, Vol. 9, No. 5, 01.02.2017.

Research output: Contribution to journalArticle

Iskandar, S, Reddy, M, Afzal, MR, Rajasingh, J, Atoui, M, Lavu, M, Atkins, D, Bommana, S, Umbarger, L, Jaeger, M, Pimentel, R, Dendi, R, Emert, M, Turagam, M, Di Biase, L, Natale, A & Lakkireddy, D 2017, 'Use of oral steroid and its effects on atrial fibrillation recurrence and inflammatory cytokines post ablation - The steroid af study', Journal of Atrial Fibrillation, vol. 9, no. 5.
Iskandar, Sandia ; Reddy, Madhu ; Afzal, Muhammad R. ; Rajasingh, Johnson ; Atoui, Moustapha ; Lavu, Madhav ; Atkins, Donita ; Bommana, Sudha ; Umbarger, Linda ; Jaeger, Misty ; Pimentel, Rhea ; Dendi, Raghuveer ; Emert, Martin ; Turagam, Mohit ; Di Biase, Luigi ; Natale, Andrea ; Lakkireddy, Dhanunjaya. / Use of oral steroid and its effects on atrial fibrillation recurrence and inflammatory cytokines post ablation - The steroid af study. In: Journal of Atrial Fibrillation. 2017 ; Vol. 9, No. 5.
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abstract = "Use of corticosteroids before and after atrial fibrillation (AF) ablation can decrease acute inflammation and reduce AF recurrence.To assess the efficacy of oral prednisone in improving the outcomes of pulmonary vein isolation with radiofrequency ablation and its effect on inflammatory cytokines, a total of 60 patients with paroxysmal AF undergoing radiofrequency ablation were randomized (1:1) to receive either 3 doses of 60 mg daily of oral prednisone or a placebo. Inflammatory cytokine levels (TNF-α, IL-1, IL6, IL-8) were measured at baseline, prior to ablation, immediately after ablation, and 24 hours post ablation. Patients underwent 30 day event monitoring at 3 months, 6 months and 12 months post procedure. Immediate post ablation levels of inflammatory cytokines were lower in the steroid group when compared to the placebo group; IL-6:9.0 ±7 vs 15.8 ±13 p=0.031; IL-8:10.5 ±9 vs 15.3 ±8; p=0.047 respectively. Acute PV reconnection rates during the procedure (7/23{\%} vs 10/36{\%}; p = 0.39), and RF ablation time (51±13 vs 56±11 min, p = 0.11) trended to be lower in the placebo group than the steroid group. There was no difference in the incidence of early recurrence of AF during the blanking period and freedom from AF off AAD at 12 months between both groups (5/17{\%} vs 8/27{\%}; p = 0.347 and 21/70{\%} vs 18/60{\%}; p=0.417 in placebo and steroid groups respectively). CONCLUSION: Although oral corticosteroids have significant effect in lowering certain cytokines, it did not impact the clinical outcomes of AF ablation.",
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AU - Rajasingh, Johnson

AU - Atoui, Moustapha

AU - Lavu, Madhav

AU - Atkins, Donita

AU - Bommana, Sudha

AU - Umbarger, Linda

AU - Jaeger, Misty

AU - Pimentel, Rhea

AU - Dendi, Raghuveer

AU - Emert, Martin

AU - Turagam, Mohit

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Lakkireddy, Dhanunjaya

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N2 - Use of corticosteroids before and after atrial fibrillation (AF) ablation can decrease acute inflammation and reduce AF recurrence.To assess the efficacy of oral prednisone in improving the outcomes of pulmonary vein isolation with radiofrequency ablation and its effect on inflammatory cytokines, a total of 60 patients with paroxysmal AF undergoing radiofrequency ablation were randomized (1:1) to receive either 3 doses of 60 mg daily of oral prednisone or a placebo. Inflammatory cytokine levels (TNF-α, IL-1, IL6, IL-8) were measured at baseline, prior to ablation, immediately after ablation, and 24 hours post ablation. Patients underwent 30 day event monitoring at 3 months, 6 months and 12 months post procedure. Immediate post ablation levels of inflammatory cytokines were lower in the steroid group when compared to the placebo group; IL-6:9.0 ±7 vs 15.8 ±13 p=0.031; IL-8:10.5 ±9 vs 15.3 ±8; p=0.047 respectively. Acute PV reconnection rates during the procedure (7/23% vs 10/36%; p = 0.39), and RF ablation time (51±13 vs 56±11 min, p = 0.11) trended to be lower in the placebo group than the steroid group. There was no difference in the incidence of early recurrence of AF during the blanking period and freedom from AF off AAD at 12 months between both groups (5/17% vs 8/27%; p = 0.347 and 21/70% vs 18/60%; p=0.417 in placebo and steroid groups respectively). CONCLUSION: Although oral corticosteroids have significant effect in lowering certain cytokines, it did not impact the clinical outcomes of AF ablation.

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