Discipline of Cardiology, Paulista School of Medicine, Federal University of São Paulo, Pedro de Toledo 781, 10th Floor (Cardiology), São Paulo, SP 04039-032, Brazil.
Europace. 2012 Jan;14(1):138-45. doi: 10.1093/europace/eur259. Epub 2011 Aug 15.
Prophylactic corticosteroids have been reported to attenuate the increase in C-reactive protein (CRP) and the incidence of atrial fibrillation (AF) both after heart surgery and AF ablation. We tested the impact of a single prophylactic corticosteroid dose on ultrasensitive CRP 24 h and 14 days after extensive linear atrial ablation (8 mm or 3.5 irrigated tip) guided by electroanatomical mapping (NavX) in pigs with normal hearts.
Pigs (n = 19; 35 kg) were divided into three groups: corticoid (n = 7), atrial ablation with administration of 500 mg methylprednisolone intravenous at anaesthetic induction; control (n = 7), atrial ablation only; and sham (n = 5), surgical procedure without ablation. Troponin and CRP were measured before, 24 h and 14 days after the procedure. After sacrifice, lesions were analysed macroscopically and histologically. Linear lesions were created in the right (n = 23) and left (n = 21) atrium of 14 animals, with no difference between groups. In all groups there was elevation of troponin and CRP 24 h after ablation, with a return to baseline values after 14 days. However, CRP levels of the control, corticoid, and sham groups were similar at all three time points analysed (baseline P = 0.52, 24 h P = 0.21, 14 days P = 0.66). Histological analysis did not show any difference between corticoid and control groups.
In this model, extensive biatrial RF ablation, per se, does not promote systemic inflammation. The use of a prophylactic single corticoid dose before ablation did not prevent systemic inflammation or alter the healing of the lesions.
有报道称，预防性皮质类固醇可减轻心脏手术后和房颤消融后 C 反应蛋白（CRP）的升高和房颤（AF）的发生率。我们测试了在正常心脏的猪中，单次预防性皮质类固醇剂量对电解剖标测（NavX）指导下广泛线性心房消融（8 毫米或 3.5 个灌注尖端）后 24 小时和 14 天超敏 CRP 的影响。
将猪（n = 19；35 公斤）分为三组：皮质组（n = 7），麻醉诱导时静脉注射 500mg 甲基强的松龙；对照组（n = 7），仅行心房消融；假手术组（n = 5），无消融的手术操作。在手术前、24 小时和 14 天后测量肌钙蛋白和 CRP。动物处死前，对病变进行大体和组织学分析。14 只动物的右心房（n = 23）和左心房（n = 21）均形成线性病变，各组间无差异。所有组在消融后 24 小时均出现肌钙蛋白和 CRP 升高，14 天后恢复基线值。然而，对照组、皮质组和假手术组在所有三个时间点的 CRP 水平均相似（基线时 P = 0.52，24 小时时 P = 0.21，14 天时 P = 0.66）。组织学分析未显示皮质组和对照组之间有任何差异。
在本模型中，广泛的双心房 RF 消融本身不会引起全身炎症。消融前使用预防性单次皮质类固醇剂量并不能预防全身炎症或改变病变的愈合。
