Influence of Steroid Therapy on the Incidence of Pericarditis and Atrial Fibrillation Following Percutaneous Epicardial Mapping and Ablation for Ventricular Tachycardia
Background—This study evaluates the influence of 3 therapeutic approaches on the incidence of pericarditis and atrial fibrillation (AF) following percutaneous epicardial mapping and ablation for ventricular tachycardia (VT).
Methods and Results—Eighty-five consecutive procedures (2006 to 2011) were retrospectively reviewed. After the first 17 procedures (20.0%), no steroids were administered. For the subsequent 30 (35.3%), systemic steroids were administered intravenously or orally (IV/PO) while the last 38 (44.7%) were followed by intrapericardial steroid injection. Compared to no steroids, the incidence of pericarditic chest pain was significantly reduced by intrapericardial steroids (58.8% vs. 21.1%, p=0.006), but not by IV/PO steroids (58.8% vs. 43.4%, p=0.31). There was no significant difference in the incidence of pericarditic ECG with steroids (36.8, 30.0%, and 41.2% for intrapericardial, IV/PO and none, respectively). There was a non-significant reduced incidence of chest pain with ECG changes with steroids (13.2%, 10.0%, and 29.4% for intrapericardial, IV/PO and none, respectively). Radiofrequency applications (65.9% of procedures), did not affect the incidence of pericarditic ECG changes, pericarditic chest pain or pericarditis (all p>0.05). In 7 (8.3%) patients with no prior history of AF, AF was documented a median 36 hours post procedure. Patients with pericarditic ECG tended to be at greater risk of AF (16.7 vs. 3.6%, p=0.091)
Conclusions—There is a high incidence of pericarditic chest pain and ECG changes following epicardial VT mapping and ablation. Pericarditic chest pain is significantly decreased by intrapericardial steroids. Procedure-related AF is relatively frequent and tends to occur more commonly with pericarditic ECG changes.
- Received October 6, 2013.
- Revision received April 23, 2014.
- Accepted May 28, 2014.