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
Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS.
Department of Cardiovascular Medicine, University of Missouri, Columbia, MO.
J Atr Fibrillation. 2017 Feb 28;9(5):1604. doi: 10.4022/jafib.1604. eCollection 2017 Feb-Mar.
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 cytokine.
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).
Although oral corticosteroids have significant effect in lowering certain cytokines, it did not impact the clinical outcomes of AF ablation.
在心房颤动（AF）消融术前和术后使用皮质类固醇可减轻急性炎症并降低AF复发率。
评估口服泼尼松对改善射频消融肺静脉隔离术结局的疗效及其对炎性细胞因子的影响。
总共60例接受射频消融的阵发性AF患者被随机（1:1）分为两组，分别接受每日3剂共60 mg的口服泼尼松或安慰剂。在基线、消融术前、消融术后即刻以及消融术后24小时测量炎性细胞因子水平（TNF-α、IL-1、IL6、IL-8）。患者在术后3个月、6个月和12个月进行30天事件监测。
与安慰剂组相比，类固醇组消融术后即刻的炎性细胞因子水平较低；IL-6：9.0±7 对比15.8±13，p = 0.031；IL-8：10.5±9对比
15.3±8；p = 0.047。术中急性肺静脉重新连接率（7/23%对比10/36%；p = 0.39）以及射频消融时间（51±13对比56±11分钟，p = 0.
11）在安慰剂组中比类固醇组有降低趋势。两组在空白期AF早期复发率以及12个月时停用抗心律失常药物（AAD）后无AF发生率方面无差异（安慰剂组和类固醇组分别为5/17%对比8/27%；p = 0.347以及21/70%对比18/60%；p = 0.417）。
虽然口服皮质类固醇在降低某些细胞因子方面有显著作用，但并未影响AF消融的临床结局。
