Methods
A cohort of 94 total adult patients was retrospectively selected in
consecutive order from a chronological database of AF ablation patients.
We included patients >18 years of age, undergoing catheter
ablation with pulmonary vein isolation for paroxysmal and persistent AF
between January and March of 2019. Only first-time ablation candidates
were included and all re-do ablation candidates were excluded to
minimize heterogeneity. Administration of intraoperative dexamethasone
was determined by chart review of the procedural anesthesia records.
Intraoperative steroids have been shown to have efficacy in reducing
PONV8-10. It is the practice within our institutions’
anesthesiology group to administer prophylactic intravenous
corticosteroids at the discretion of the anesthesiologist for PONV
prophylaxis, independent of the electrophysiologist performing the
ablation. Thus, at the time of the procedure, the operator was
essentially “blinded” to the administration of dexamethasone. AF
recurrence was determined by electrocardiogram or cardiac monitoring
device at less than 3 months and 3 months to 1 year, which was obtained
at the time of in-person follow-up visit. The protocol was approved by
our institutional review board and all patients provided informed
consent.
Demographic information for each patient was obtained via a review of
the electronic medical record. Administration of dexamethasone and
dosing was determined by review of procedural medication administration
records. Dexamethasone dosing was determined at the discretion of the
anesthesiologist. Patients in the dexamethasone group either received 4
mg or 8 mg of intravenous dexamethasone during the catheter ablation
procedure. Patients in the control group did not receive any intravenous
steroids including dexamethasone at the time of the catheter ablation
procedure. Administration of other steroidal and non-steroidal
anti-inflammatory agents at the time of ablation and in the
postoperative period was also reviewed. Additionally, the concomitant
use of antiarrhythmic agents was determined by chart review