Antiarrhythmic drug therapy after radiofrequency catheter ablation in patients with atrial fibrillation. Effect of a single bolus injection of low-dose hydrocortisone for prevention of atrial fibrillation recurrence after radiofrequency catheter ablation. Effects of Alpha Lipoic Acid on Multiple Cytokines and Biomarkers and Recurrence of Atrial Fibrillation Within 1 Year of Catheter Ablation. The usefulness of global left atrial strain for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent and paroxysmal atrial fibrillation. Left atrial strain as predictor of successful outcomes in catheter ablation for atrial fibrillation: a two-dimensional myocardial imaging study Use of Oral Steroid and its Effects on Atrial Fibrillation Recurrence and Inflammatory Cytokines Post Ablation - The Steroid AF Study. Incidence and time course of early recovery of pulmonary vein conduction after catheter ablation of atrial fibrillation. Response to flecainide infusion predicts long-term success of hybrid pharmacologic and ablation therapy in patients with atrial fibrillation. Usefulness of serum uric acid level to predict atrial fibrillation recurrence after cryoballoon-based catheter ablation. Incidence and Significance of Early Recurrences of Atrial Fibrillation After Cryoballoon Ablation: Insights From the Multicenter Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Trial
OBJECTIVES The use of antiarrhythmic drugs after ablation is a controversial issue when evaluating the efficacy of atrial fibrillation ( AF ) ablation . This study compares in a prospect i ve and r and omized fashion the impact of an antiarrhythmic drug in preventing AF recurrence after AF ablation . METHODS From February 2004 to May 2005 , 107 consecutive patients ( mean age 57 + /- 10 years , 69 men ) , with paroxysmal ( 60 % ) or persistent ( 40 % ) drug refractory AF , were r and omly assigned to ablation alone ( Group A , 53 patients ) or combined with the best antiarrhythmic therapy , preferably amiodarone ( Group B , 54 patients ) . All patients underwent cavo-tricuspid and left inferior pulmonary vein (PV)-mitral isthmus ablation plus circumferential PV ablation , using a guided electro-anatomical approach . St and ard electrocardiograms ( ECG ) , and ambulatory and transtelephonic ECG monitoring  were used to assess AF recurrences . Recurrences during the first month after ablation were excluded from this analysis . RESULTS At 12 months of follow-up , no significant difference was observed in the rates of AF recurrences between Group A ( 18/53 patients , 34 % ) and Group B ( 16/54 patients , 30 % ) . The percentage of patients with > /= 1 asymptomatic AF episode was higher in Group B than in Group A ( 10/16 patients , 63 % , vs 5/18 patients , 28 % , P = 0.04 ) . CONCLUSIONS Continuing antiarrhythmic drug therapy in patients who undergo catheter ablation for AF did not lower the rate of AF recurrences . Antiarrhythmic drugs increased the proportion of patients with asymptomatic AF episodes BACKGROUND The transient use of corticosteroid shortly after atrial fibrillation ( AF ) ablation might prevent immediate and mid-term AF recurrence ; however , the effective dosage for preventing AF recurrence has not been determined . In this study , we evaluated whether low-dose hydrocortisone is effective for the prevention of AF recurrence after radiofrequency catheter ablation ( RFCA ) . METHODS AND RESULTS We enrolled 89 AF patients ( 70 males , 55.8 ± 10.9 years ) who underwent RF ablation and were treated with single bolus injection of 100 mg hydrocorticosteroid ( corticosteroid group ) . For the control group , we enrolled 120 sex- and age-matched AF patients ( 94 males , 55.4 ± 10.5 years ) . Pericarditis occurred in 3 ( 2.5 % ) and 1 ( 1.1 % ) patients in the control and corticosteroid groups , respectively . The number of patients with immediate AF recurrence ( ≤ 2 days ) was 17 ( 14.5 % ) and 11 ( 12.4 % ) in the control and steroid groups , respectively ( P=0.687 ) . Treatment with low-dose steroid did not decrease early ( 3 - 30 days ) AF recurrence ( 13 [ 11.1 % ] vs. 11 [ 12.5 % ] , P=0.829 ) or late ( ≥ 31 days ) AF recurrence after ablation ( 26 [ 22.2 % ] vs. 13 [ 14.6 % ] , P=0.209 ) . There was no difference in cumulative survival free of late AF recurrence between the corticosteroid and control groups ( P=0.57 by log-rank test ) . White blood cell count , C-reactive protein concentration and maximum body temperature also were unchanged by low-dose steroid . CONCLUSIONS Single bolus injection of low-dose hydrocortisone after AF ablation is not effective for preventing AF recurrence during the mid-term follow-up period Catheter ablation ( CA ) is a procedure commonly used to restore sinus rhythm in patients with atrial fibrillation ( AF ) . However , AF recurrence after CA remains a relevant clinical issue . We tested the effects of an oral antioxidant treatment ( alpha lipoic acid [ ALA ] ) on AF recurrence post-CA . Patients with paroxysmal AF have been enrolled in a r and omized , prospect i ve , double-blind , controlled placebo trial . After CA , patients have been r and omly assigned to receive ALA oral supplementation ( ALA group ) or placebo ( control group ) and evaluated at baseline and after a 12-month follow-up : 73 patients completed the 12-month follow-up  ( ALA : 33 and control : 40 ) . No significant difference has been detected between the 2 groups at baseline . Strikingly , 1 year after CA , ALA therapy significantly reduced serum markers of inflammation . However , there was no significant difference in AF recurrence events at follow-up comparing ALA with placebo group . Multivariate analysis revealed that the only independent prognostic risk factor for AF recurrence after CA is age . In conclusion , ALA therapy reduces serum levels of common markers of inflammation in ablated patients . Nevertheless , ALA does not prevent AF recurrence after an ablative treatment BACKGROUND Given the potential complications of atrial fibrillation ( AF ) recurrence after ablation , better predictors of the effectiveness of the procedure are necessary to guide patient selection . AIM This prospect i ve study was conducted to evaluate the clinical relevance of global left atrial longitudinal strain ( GLAS ) and AF recurrence after catheter ablation . METHODS In 115 consecutive patients with AF ( persistent , n=62 ; paroxysmal , n=53 ) ,  transthoracic echocardiography was performed before catheter ablation to assess baseline left atrial mechanical function using speckle tracking echocardiography ( STE ) . RESULTS After 12 months of follow-up , 22 ( 35.5 % ) patients in the persistent AF group and 15 ( 28.3 % ) in the paroxysmal AF group exhibited AF recurrence . In both the paroxysmal and persistent AF population s , patients with recurrence presented with significantly impaired GLAS compared with patients without recurrence . Patients with recurrence also had a significantly higher pro-B-type natriuretic peptide concentration . A receiver operator curve analysis yielded area under the curve values of 0.94 and 0.86 for paroxysmal and persistent AF , respectively . In a multivariable Cox proportional-hazards analysis , GLAS was an independent predictor of AF recurrence after catheter ablation in both the paroxysmal AF group ( hazard ratio : 0.79 , 95 % confidence interval : 0.67 - 0.96 ; P=0.01 ) and the persistent AF group ( hazard ratio : 0.81 , 95 % confidence interval : 0.71 - 0.93 ; P=0.004 ) . CONCLUSIONS In both paroxysmal and persistent AF , decreased baseline left atrial deformation capabilities assessed by two-dimensional STE can help to identify patients at high risk of AF recurrence after catheter ablation . This variable may help to guide c and i date selection and improve therapeutic strategies Background The objective of this study was to investigate atrial myocardial properties through two-dimensional ( 2D ) myocardial imaging in patients with atrial fibrillation ( AF ) and its predictive role for recurrence after catheter ablation . Methods and results Echocardiographic examinations were performed in 40 patients with paroxysmal AF before catheter ablation and 40 age- and gender-matched healthy control subjects . Using a software package , bidimensional acquisitions were analyzed to measure longitudinal strain and strain rate for the left atrium ( LA ) . Systolic strain and strain rate in all eight segments , and its average values , were significantly reduced in AF patients compared to controls . During 9 months of follow-up after catheter ablation for AF , 11 of 40 AF patients had AF recurrence . AF recurrence was associated with gender , LA volume index , and average values of systolic strain and strain rate . By multivariate analysis , only average strain was an independent predictor of AF recurrence ( OR = 0.88 , 95 % CI 0.79 - 0.98 , p = 0.018 ) . Conclusions Lower systolic strain of LA was strongly associated with recurrence after catheter ablation . Thus , diverse adjunctive ablation strategies should be considered to reduce recurrence in patients with lower systolic strain Background Use of corticosteroids before and after atrial fibrillation ( AF ) ablation can decrease acute inflammation and reduce AF recurrence . Purpose To assess the efficacy of oral prednisone in improving the outcomes of pulmonary vein isolation with radiofrequency ablation and its effect on inflammatory cytokine . Methods A total of 60 patients with paroxysmal AF undergoing radiofrequency ablation were r and omized ( 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 . Results 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 BACKGROUND Although it is well recognized that recovery of pulmonary vein ( PV ) conduction is common among patients who fail atrial fibrillation ( AF ) ablation  , little is known about the precise time course of recurrence . OBJECTIVE To determine the incidence and time course of early recurrence of conduction after PV isolation during AF ablation . METHODS The patient population was composed of 14 consecutive patients ( 9 men [ 64 % ] ; age 56 + /- 7 years ) with AF who underwent radiofrequency catheter ablation via circumferential ablation with PV isolation , determined by a circular mapping catheter .  After successful isolation of the PVs , repeat circular electrode recordings from each PV were obtained at 30 and 60 minutes . RESULTS After complete isolation of all PVs , early PV recurrence was observed in 13 ( 93 % ) patients and 26 veins ( 50 % ) . Seventeen veins ( 33 % ) showed a first recurrence at 30 minutes , while nine veins ( 17 % ) showed a first recurrence at 60 minutes . CONCLUSION The results reveal an extremely high rate of early recurrence of PV conduction following AF ablation . It is particularly notable that about one-fifth of the veins remained isolated at 30 minutes , but subsequently developed recurrence between 30 and 60 minutes . Of the veins that showed early recurrence , one-third developed a first recurrence at 60 minutes . These findings suggest that AF ablation procedures should incorporate a 60-minute waiting period after initial isolation in order to detect early recurrence of conduction OBJECTIVES We tested the hypothesis that the response to flecainide infusion can identify patients with atrial fibrillation ( AF ) in whom the hybrid pharmacologic and ablation therapy reduces the recurrences of AF . BACKGROUND Infusion of class IC anti-arrhythmic drugs may promote transformation of AF into atrial flutter . Catheter ablation of atrial flutter has been demonstrated to be highly effective in preventing recurrences of atrial flutter . METHODS Seventy-one consecutive patients with paroxysmal or chronic AF , in whom flecainide infusion ( 2 mg/kg body weight , intravenously ) determined the transformation of AF into common atrial flutter ( positive response ) , were r and omized to receive one of the following treatments : oral pharmacologic treatment with flecainide ( group A , n = 23 ) ; the hybrid treatment ( catheter ablation of the inferior vena cava-tricuspid annulus isthmus , plus oral flecainide ) ( group B , n = 24 ) ; or catheter ablation of the isthmus only ( group C , n = 24 ) . Thirty-seven patients with a negative response to flecainide , who chose to be su bmi tted to the hybrid treatment , were selected as the control group ( group D ) . RESULTS During a mean follow-up period of 24 + /- 7.2 months , the recurrences of AF and atrial flutter in group B ( 42 % ) were significantly lower than those in group A ( 78 % , p < 0.001 ) , group C ( 92 % , p < 0.001 ) and group D ( 92 % , p < 0.001 ) . CONCLUSIONS The creation of a complete bi-directional conduction block at the inferior vena cava-tricuspid annulus isthmus , plus flecainide administration , reduces the recurrences of both AF and atrial flutter in patients with class IC atrial flutter . Moreover , the early response to flecainide is safe and reliable in identifying patients who may benefit from this therapy AIMS Catheter-based atrial fibrillation ( AF ) ablation has become an important therapeutic option in AF patients . Although there has been significant improvent in procedural success , post-procedural AF recurrences are continuing to be a major clinical problem . To the best of our knowledge , the impact of pre-procedural serum uric acid ( SUA ) level , as a pro-oxidant and pro-inflammatory marker , on AF recurrence following cryoballoon-based AF ablation has never been studied before . The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation . METHODS AND RESULTS A total of 363 patients ( mean age 53.5 ± 11.2 years , 52.6 % male ) with symptomatic paroxysmal AF underwent initial cryoablation procedure .  Patients were categorized into quartiles on the basis of their pre-procedural SUA assays and follow-up , and the Kaplan-Meier estimation with a log-rank test was used for the analysis of the influence of SUA on the recurrence of AF . Post-ablation blanking period was observed for 3 months . At a mean follow-up of 19.2 ± 6.1 months , 68 patients ( 18.7 % ) had developed AF recurrence . Atrial fibrillation recurrence rates from the lowest to the highest SUA quartiles were 2.9 , 7.4 , 11.8 , and 77.9 % , respectively ( P < 0.001 ) . On multivariate Cox regression analysis , pre-ablation SUA level ( HR : 1.96 , 95 % CI : 1.49 - 2.59 , P < 0.001 ) , left atrial diameter ( HR : 1.11 , 95 % CI : 1.04 - 1.19 , P = 0.002 ) and early AF recurrence ( HR : 4.34 , 95 % CI : 1.9 - 9.95 , P = 0.001 ) were independent predictors of AF recurrence after cryoablation . Using a cut-off level of 6.37 , the pre-ablation SUA level predicted AF recurrence during follow-up with a sensitivity of 85.7 % and a specificity of 83.7 % . CONCLUSION In this prospect i ve study of patients with paroxysmal AF undergoing cryoablation , increased pre-ablation SUA levels were associated with a higher rate of AF recurrence . Our results support the role of a pre-ablation pro-inflammatory and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important Background —Early recurrence of atrial fibrillation ( ERAF ) is common after radiofrequency catheter ablation for AF . We sought to determine the incidence and prognostic significance of ERAF after cryoballoon ablation . Moreover , the benefit of early reablation for ERAF after cryoballoon ablation is undetermined . Methods and Results —The Sustained Treatment of Paroxysmal Atrial Fibrillation ( STOP AF ) trial r and omized 245 patients with paroxysmal AF to medical therapy versus cryoballoon-based pulmonary vein ablation .  Patients were followed for 12 months . ERAF was defined as any recurrence of AF > 30 seconds during the first 3 months of follow-up . Late recurrence ( LR ) was defined as any recurrence of AF > 30 seconds between 3 and 12 months . Of the 163 patients r and omized to cryoablation , 84 patients experienced ERAF ( 51.5 % ) . The only significant factor associated with ERAF was male sex ( hazard ratio [ HR ] , 2.18 ; 95 % confidence interval [ CI ] , 1.03–4.61 ; P=0.041 ) . LR was observed in 41 patients ( 25.1 % ) , and was significantly related to ERAF ( 55.6 % LR with ERAF versus 12.7 % without ERAF ; P<0.001 ) . Among patients with ERAF , only current tobacco use ( HR , 3.84 ; 95 % CI , 1.82–8.11 ; P<0.001 ) was associated with LR . Conversely , early reablation was associated with greater freedom from LR ( 3.3 % LR with early reablation versus 55.6 % without ; HR , 0.04 ; 95 % CI , 0.01–0.32 ; P=0.002 ) . Conclusions —ERAF after cryoballoon ablation occurs in ≈50 % of patients and is strongly associated with LR . Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF
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 .
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 r and omized clinical trials ( RCTs ) and observational studies to ascertain the association of steroids and  AF recurrence  after ablation .