Abstract 2754: Pulmonary Vein Isolation Using Irrigated vs. Conventional 4-mm Tip Catheters- Do Short and Long-Term Outcomes Differ?

Open saline-irrigated tip ablation catheters have largely supplanted standard 4 mm tip ablation catheters for pulmonary vein isolation (PVI) of atrial fibrillation (AF), based on the assumption that the procedure is safer and more efficacious. However, outcomes after procedures that use identical techniques but different radiofrequency ablation catheters have not been compared. We studied 432 consecutive patients (age 57 ± 11 yrs) with AF (duration 7.9 ± 6.1 yrs) who underwent PVI; 320 (74 %) using a conventional 4 mm catheter and 112 (26 %) using an open irrigated tip catheter. Segmental PVI targeting the earliest LA-PV activation for all PVs in each patient was used for all patients regardless of catheter for the entire study cohort. Radiofrequency energy was delivered for ≥60 secs at each target site. The pts in the 2 groups were similar with respect to age, gender and duration of AF. All 432 pts had successful complete PVI. There was no significant difference in the total number of lesions delivered per PV in the conventional 4 mm group and the irrigated tip group (Table ) at the initial procedure. Following a single procedure, 227/ 320 (71%) patients in the conventional 4 mm and 75/112 (67%) in the irrigated group were AF-free on no antiarrhythmic drug at 12 mos (p=0.43). The number of patients who required repeat procedures was similar in the conventional group (57/320, 18%) and the irrigated tip group (22/112, 20%) (p=0.66). Serious complications were also similar (2.2% vs. 1.0 %, p=0.21) Contrary to conventional wisdom, the safety and 12 month efficacy of PVI for management of AF was similar for the two types of ablation catheters. These data suggest that PVI cohorts derived from differing ablation techniques can be combined for purposes of clinical investigation. Longer term outcomes may differ and should be studied as well.

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Complete remission of metastatic osteosarcoma using combined modality therapy: a retrospective analysis of unselected patients in China

BMC Cancer ◽

10.1186/s12885-021-08071-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lu Xie ◽

Jie Xu ◽

Xiaowei Li ◽

Zuli Zhou ◽

Hongqing Zhuang ◽

...

Keyword(s):

Pulmonary Metastases ◽

Local Therapy ◽

Hypofractionated Radiotherapy ◽

Study Cohort ◽

Sufficient Information ◽

Progression Rate ◽

Entire Study ◽

Pulmonary Lesions ◽

Metastatic Osteosarcoma ◽

Significant Difference

Abstract Background Complete surgical remission (CSR) is the best predictor of overall survival (OS) for patients with metastatic osteosarcoma. However, metastasectomy has not been widely implemented in China in the last decade due to various factors, and instead, most physicians choose hypofractionated radiotherapy to treat pulmonary lesions. This study aimed to retrospectively evaluate the outcomes of different local treatments for pulmonary lesions and identify the best local therapy strategies for these patients. Methods We reviewed the clinical courses of osteosarcoma patients with pulmonary metastases who were initially treated in two sarcoma centres in Beijing, China, from June 1st, 2009, to March 26th, 2020. With a median follow-up of 32.4 (95% confidence interval (CI): 30.8, 36.1) months, a total of 127 patients with 605 pulmonary nodules, all of whom had received local therapy and firstly achieved CSR or complete radiated/metabolic remission (CRR), were included in the analysis. A total of 102 patients with 525 nodules were initially diagnosed with resectable lung metastases, while 25 patients had 80 indeterminate nodules at presentation and relapsed with pulmonary metastases within 6 months after the completion of adjuvant chemotherapy. Results Eighty-eight of 127 (69.3%) patients had fewer than 5 nodules at the time of local therapy, with 48 of 127 (37.8%) located in the unilateral pleura. No patient underwent thoracotomy, and 42 of 127 patients (85 nodules) received video-assisted thoracoscopic surgery (VATS). In addition, 79 of 127 patients (520 nodules) received hypofractionated stereotactic body radiotherapy (RT), such as Gamma Knife radiosurgery or CyberKnife radiosurgery. The twelve-month event-free survival (EFS) (from local therapy to progression) rate of this entire study cohort was 35.6% (95% CI: 26.8, 44.4%), without a significant difference between the two groups (44.7% for VATS vs. 28.4% for RT, P = 0.755). Radiation-induced pneumonitis was observed in 62 of 86 (72.1%) patients, with one patient (1/86, 1.2%) in grade 4. Conclusions Our past data showed a similar prognosis with the use of hypofractionated radiotherapy and VATS for the treatment of pulmonary metastasis and no inferiority to thoracotomy regarding historical outcomes. Currently, high-resolution chest computed tomography (CT) provides sufficient information on nodules, and less invasive modalities can thus be considered for treatment.

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B-PO03-112 ACUTE CHANGE IN PARASYMPATHETIC CARDIAC INNERVATION AFTER PULMONARY VEIN ISOLATION BY PULSE-FIELD AND RADIOFREQUENCY ENERGY

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.586 ◽

2021 ◽

Vol 18 (8) ◽

pp. S234

Author(s):

Predrag Stojadinovic ◽

Dan Wichterle ◽

Petr Peichl ◽

Robert Cihak ◽

Helena Jansova ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Pulse Field ◽

Radiofrequency Energy ◽

Cardiac Innervation ◽

Acute Change

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Myocardial injury after pulmonary vein isolation: fire versus ice

European Heart Journal ◽

10.1093/eurheartj/ehab724.0368 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A R Morgado Gomes ◽

N S C Antonio ◽

S Silva ◽

M Madeira ◽

P Sousa ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Troponin I ◽

Surrogate Marker ◽

High Sensitivity ◽

Cryoballoon Ablation ◽

Single Shot ◽

High Sensitivity Troponin ◽

Ablation Index ◽

Significant Difference

Abstract Introduction The cornerstone of atrial fibrillation (AF) catheter ablation is pulmonary vein isolation (PVI), either using point-by-point radiofrequency ablation (RF) or single-shot ablation devices, such as cryoballoon ablation (CB). However, achieving permanent transmural lesions is difficult and pulmonary vein (PV) reconnection is common. Elevation of high-sensitivity Troponin I (hsTnI) may be used as a surrogate marker for transmural lesions. Still, data regarding the comparison of hsTnI increase after PVI with RF or cryo-energy is controversial. Purpose The aim of this study is to compare the magnitude of hsTnI elevation after PVI with CB versus RF using ablation index guidance. Methods Prospective study of 60 patients admitted for first ablation procedure of paroxysmal or persistent AF in a single tertiary Cardiology Department. Thirty patients were submitted to PVI using CB and 30 patients were submitted to RF, using CARTO® mapping system and ablation index guidance. Patients with atrial flutter were excluded. Baseline characteristics were compared between groups, as well as hsTnI before and after the procedure. Results Mean age was 57.9±12.3 years old, 62% of patients were male and 77% had paroxysmal AF. There were no significant differences between groups regarding gender, age, prevalence of hypertension, dyslipidaemia, diabetes, obesity or AF type. There was also no significant difference in electrical cardioversion need during the procedure. HsTnI median value before ablation was 1.90±1.98 ng/dL. Postprocedural hsTnI was significantly higher in CB-group (6562.7±4756.2 ng/dL versus 1564.3±830.7 ng/dL in RF-group; P=0.001). Regarding periprocedural complications, there was only one case of mild pericardial effusion in RF-group associated with postablation hsTnI of 1180.0 ng/dL. Conclusions High-sensitivity Troponin I was significantly elevated after PVI, irrespective of the ablation technique. In CB-group, hsTnI elevation was significantly higher than in RF-group. This disparity may reflect more extensive lesions with cryoablation, without compromising safety. Longterm studies are needed to understand whether this hsTnI elevation is predictive of a lower AF recurrence rate. FUNDunding Acknowledgement Type of funding sources: None.

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Kolmogorov Complexity of Coronary Sinus Atrial Electrograms before Ablation Predicts Termination of Atrial Fibrillation after Pulmonary Vein Isolation

Entropy ◽

10.3390/e21100970 ◽

2019 ◽

Vol 21 (10) ◽

pp. 970 ◽

Cited By ~ 1

Author(s):

Stępień ◽

Kuklik ◽

Żebrowski ◽

Sanders ◽

Derejko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Coronary Sinus ◽

Kolmogorov Complexity ◽

Similarity Index ◽

Dominant Frequency ◽

Significant Difference ◽

The Rich

Atrial fibrillation (AF) is related to a very complex local electrical activity reflected in the rich morphology of intracardiac electrograms. The link between electrogram complexity and efficacy of the catheter ablation is unclear. We test the hypothesis that the Kolmogorov complexity of a single atrial bipolar electrogram recorded during AF within the coronary sinus (CS) at the beginning of the catheter ablation may predict AF termination directly after pulmonary vein isolation (PVI). The study population consisted of 26 patients for whom 30 s baseline electrograms were recorded. In all cases PVI was performed. If AF persisted after PVI, ablation was extended beyond PVs. Kolmogorov complexity estimated by Lempel–Ziv complexity and the block decomposition method was calculated and compared with other measures: Shannon entropy, AF cycle length, dominant frequency, regularity, organization index, electrogram fractionation, sample entropy and wave morphology similarity index. A 5 s window length was chosen as optimal in calculations. There was a significant difference in Kolmogorov complexity between patients with AF termination directly after PVI compared to patients undergoing additional ablation (p < 0.01). No such difference was seen for remaining complexity parameters. Kolmogorov complexity of CS electrograms measured at baseline before PVI can predict self-termination of AF directly after PVI.

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P2846Focal impulse and rotor modulation ablation versus pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation (FIRMAP AF study)

European Heart Journal ◽

10.1093/eurheartj/ehz748.1156 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Tilz ◽

C L Lenz ◽

P S Sommer ◽

N Sawan ◽

R Meyer-Saraei ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Gold Standard ◽

Artery Aneurysm ◽

Rf Ablation ◽

Af Ablation ◽

Number Of Patients

Abstract Background Based on the assumption of trigger elimination, pulmonary vein isolation (PVI) currently presents the gold standard of atrial fibrillation (AF) ablation. Recently, rapidly spinning rotors or focal impulse formation has been raised as a crucial sustaining mechanism of AF. Ablation of these rotors may potentially obviate the need for trigger elimination with PVI. Purpose This study sought to compare the safety and effectiveness of Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation only with the gold standard of pulmonary vein isolation (PVI) in patients with paroxysmal AF. Methods This was a post-market, prospective, single-blinded, randomized, multi-center trial. Patients were enrolled at three centers and equally (1:1) randomized between those undergoing conventional RF ablation with PVI (PVI group) vs. those treated with FIRM-guided RF ablation without PVI (FIRM group). Data was collected at enrollment, procedure, and at 7-day, 3-month, 6-month, and 12-month follow-up visits. The study was closed early by the sponsor. At the time of study closure, any pending follow-up visits were waived. Results From February 2016 until February 2018, a total of 51 (out of a planned 170) patients (mean age 63±10.6 years, 57% male) were enrolled and randomized. Four patients withdrew from the study prior to treatment, resulting in 23 patients allocated to the FIRM group and 24 in the PVI group. Only 13 patients in the FIRM group and 11 patients in the PVI group completed the 12-month follow-up. Statistical analysis was not completed given the small number of patients. Single-procedure effectiveness (freedom from AF/atrial tachycardia recurrence after blanking period) was 52.9% (9/17) in the FIRM group and 85.7% (12/14) in the PVI group at 6 months; and 31.3% (5/16) in the FIRM group and 80% (8/10) in the PVI group at 12 months. Repeat procedures were performed in 45.8% (11/24) patients in the FIRM group and 7.4% (2/27) in the PVI group. The acute safety endpoint [freedom from procedure-related serious adverse events (SAE)] was achieved in 87% (20/23) of FIRM group patients and 100% (24/24) of PVI group patients. Procedure related SAEs occurred in three patients in the FIRM group: 1 femoral artery aneurysm and 2 injection site hematomas. No additional procedure-related SAEs were reported >7 days post-procedure. Conclusions These partial study effectiveness results reinforce the importance of PVI in paroxysmal atrial fibrillation patients and suggest that FIRM-guided ablation alone (without PVI) is not an effective strategy for treatment of paroxysmal AF in most patients. Further study is needed to understand the effectiveness of adding FIRM-guided ablation as an adjunct to PVI in this patient group. Acknowledgement/Funding Abbot

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Intraprocedural endpoints to predict durable pulmonary vein isolation: a randomized trial of four post-ablation techniques

EP Europace ◽

10.1093/europace/euz301 ◽

2019 ◽

Vol 22 (4) ◽

pp. 567-575 ◽

Cited By ~ 4

Author(s):

Ruhong Jiang ◽

Minglong Chen ◽

Bing Yang ◽

Qiang Liu ◽

Zuwen Zhang ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Af Ablation ◽

Group 4 ◽

Initial Procedure ◽

Group 2 ◽

Waiting Periods ◽

The Impact ◽

Af Recurrence

Abstract Aims The optimal procedural endpoint to achieve permanent pulmonary vein isolation (PVI) during ablation of atrial fibrillation (AF) remains unknown. We aimed to compare the impact of prolonged waiting periods and adenosine triphosphate (ATP) testing after PVI on long-term freedom from AF. Methods and results In total, 538 patients (median age 61 years, 62% male) undergoing first-time radiofrequency ablation for paroxysmal AF were randomized into four groups: Group 1 [PVI (no testing), n = 121], Group 2 (PVI + 30min waiting phase, n = 151), Group 3 (PVI+ATP, n = 131), and Group 4 (PVI + 30min+ATP, n = 135). The primary endpoint was freedom from AF. Repeat mapping to assess for late pulmonary vein (PV) reconnection was performed in patients who remained AF-free for >3 years (n = 46) and in those who had repeat ablation for AF recurrence (n = 82). During initial procedure, acute PV reconnection was observed in 33%, 26%, and 42% of patients in Groups 2, 3, and 4, respectively. At 36 months, no significant differences in freedom from AF recurrence were observed among all four groups (55%, 61%, 50%, and 62% for Groups 1, 2, 3, and 4, respectively; P = 0.258). Late PV reconnection was commonly observed, with a similar incidence between patients with and without AF recurrence (74% vs. 83%; P = 0.224). Conclusion Although PVI remains the cornerstone for AF ablation, intraprocedural techniques to assess for PV reconnection did not improve long-term success. Patients without AF recurrence after 3 years exhibited similarly high rates of PV reconnection as those that underwent repeat ablation for AF recurrence. The therapeutic mechanisms of AF ablation may not be solely predicated upon durable PVI.

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P1417Short and long term efficiency of different therapeutic approaches to perimitral atrial flutter

EP Europace ◽

10.1093/europace/euaa162.114 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

P Kupo ◽

R Pap ◽

G Bencsik ◽

L Saghy

Keyword(s):

Retrospective Study ◽

Atrial Flutter ◽

Pulmonary Vein ◽

Success Rates ◽

Therapeutic Approaches ◽

Significant Difference ◽

Mitral Isthmus ◽

Short And Long Term ◽

Left Pulmonary Vein

Abstract Introduction Catheter ablation of perimitral flutter can be challenging, owing to difficult anatomy. The most commonly applied procedure is the creation of a mitral isthmus line (between the lower left pulmonary vein and the mitral anulus) or an anteroseptal line (between the upper right pulmonary vein and the anterior mitral anulus). Purpose Our study aimed to compare the short and long term efficacy of two different ablation methods. Methods In our retrospective study 45 consecutive patients diagnosed with perimitral flutter were included between 2009 and 2018. Results Radiofrequency ablation was performed in 48 cases in 31 patients (mitral isthmus line (n = 25, 52.1%); anteroseptal line (n = 23, 47.9%)). Arrhythmia-termination and sinus rhythm restoration could be achieved in 64.6% of the cases (mitral isthmus line: 16/25 (64.0%), anteroseptal line: 15/23 (65.2%). Comparing two different techniques, there was no significant difference (p = 0.85) in acute success rates. During 24.3 months of follow-up period, in 60.0% of the patients no recurrence occurred. The arrhythmia recurred in 6 cases (40.0%) after anteroseptal line ablation, and in 8 cases (53.3%) after mitral isthmus line ablation. No difference was found in the long term efficiency of two different ablation techniques (p = 0.211). Conclusion In our retrospective study we found no significant difference in the short and long term efficiency of two different therapeutic approaches to perimitral atrial flutter.

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Safety of conscious sedation in electroanatomical mapping procedures and cryoballoon pulmonary vein isolation

Heart and Vessels ◽

10.1007/s00380-020-01725-7 ◽

2020 ◽

Author(s):

Karolina Weinmann ◽

Regina Heudorfer ◽

Alexia Lenz ◽

Deniz Aktolga ◽

Manuel Rattka ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Conscious Sedation ◽

Cryoballoon Ablation ◽

Electroanatomical Mapping ◽

Transcutaneous Oxygen ◽

Transcutaneous Oxygen Saturation ◽

Significant Difference ◽

Electrophysiological Procedures ◽

Procedure Duration

AbstractImmobilization of patients during electrophysiological procedures, to avoid complications by patients’ unexpected bodily motion, is achieved by moderate to deep conscious sedation using benzodiazepines and propofol for sedation and opioids for analgesia. Our aim was to compare respiratory and hemodynamic safety endpoints of cryoballoon pulmonary vein isolation (PVI) and electroanatomical mapping (EAM) procedures. Included patients underwent either cryoballoon PVI or EAM procedures. Sedation monitoring included non-invasive blood pressure measurements, transcutaneous oxygen saturation (tSpO2) and transcutaneous carbon-dioxide (tpCO2) measurements. We enrolled 125 consecutive patients, 67 patients underwent cryoballoon atrial fibrillation ablation and 58 patients had an EAM and radiofrequency ablation procedure. Mean procedure duration of EAM procedures was significantly longer (p < 0.001) and propofol doses as well as morphine equivalent doses of administered opioids were significantly higher in EAM patients compared to cryoballoon patients (p < 0.001). Cryoballoon patients display higher tpCO2 levels compared to EAM patients at 30 min (cryoballoon: 51.1 ± 7.0 mmHg vs. EAM: 48.6 ± 6.2 mmHg, p = 0.009) and at 60 min (cryoballoon: 51.4 ± 7.3 mmHg vs. EAM: 48.9 ± 6.6 mmHg, p = 0.07) procedure duration. Mean arterial pressure was significantly higher after 60 min (cryoballoon: 84.7 ± 16.7 mmHg vs. EAM: 76.7 ± 13.3 mmHg, p = 0.017) in cryoballoon PVI compared to EAM procedures. Regarding respiratory and hemodynamic safety endpoints, no significant difference was detected regarding hypercapnia, hypoxia and episodes of hypotension. Despite longer procedure duration and deeper sedation requirement, conscious sedation in EAM procedures appears to be as safe as conscious sedation in cryoballoon ablation procedures regarding hemodynamic and respiratory safety endpoints.

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P984Residual gaps in the ablation line and requirement for carina ablation during contact force-guided radiofrequency pulmonary vein isolation: determinants and prognostic implications

European Heart Journal ◽

10.1093/eurheartj/ehz747.0577 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M J Mulder ◽

M J B Kemme ◽

M J W Gotte ◽

H A Hauer ◽

G J M Tahapary ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Contact Force ◽

Pulmonary Veins ◽

Survival Analyses ◽

Kaplan Meier ◽

Significant Difference ◽

Prognostic Implications ◽

Ablation Line ◽

Af Recurrence

Abstract Background Pulmonary vein isolation (PVI) is not always achieved after initial encircling of the pulmonary veins (PVs). Additional touch-up lesions are frequently required to close residual gaps, which may occur both in the initial ablation line and on the intervenous carina. Purpose We aimed to identify determinants and prognostic implications of residual gaps during index radiofrequency PVI. Methods Two hundred fourteen AF (atrial fibrillation) patients (57% paroxysmal, 61% male, mean age 62±9 years) undergoing contact force-guided PVI were studied. Residual gaps after initial encircling of the PVs were targeted for additional ablation and were classified as either gap ablation in the initial WACA (wide-area circumferential ablation) circle or carina ablation, depending on the site of earliest activation. After a waiting period of at least 30 minutes, persistence of PVI was tested through administration of 9–18 mg intravenous adenosine. Pre-procedural cardiac computed tomography imaging was used to assess left atrial and PV anatomy. Carina width was defined as the distance between ipsilateral superior and inferior PV ostia. Ablation procedures were analyzed to define the perimeter of the WACA circle. Results One hundred thirty-three patients (62%) required additional ablation lesions beyond the initial WACA circles to achieve complete PVI. Gap ablation was required in the left WACA circle in 34 patients (16%) and in the right WACA circle in 49 patients (23%). Left and right carina ablation were required in 50 (23%) and 83 (39%) patients, respectively. Multivariate analyses identified carina width and perimeter of the WACA circle as independent predictors of requirement for ipsilateral carina ablation, whereas paroxysmal AF and the perimeter of the WACA circle were associated with requirement of gap ablation in the initial WACA circle. Recurrence of atrial tachyarrhythmias was documented in 73 patients (34%) at 12 months follow-up. Kaplan–Meier survival analyses demonstrated a significantly higher rate of recurrence in patients with one or more residual gaps in the ablation line (43% vs. 30%, p=0.019, figure A), whereas no significant difference between patients with and without requirement of carina ablation was found (38% and 29%, respectively; p=0.111, figure B). Kaplan-Meier survival analyses Conclusion Residual gaps in the initial WACA circle were associated with increased AF recurrence rate after PVI, whereas residual gaps on the intervenous carina had no statistically significant impact on AF recurrence. Consequently, gaps occurring in the ablation line and gaps on the intervenous carina may represent different mechanisms and may have different prognostic implications.

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Abstract 2756: Prevention of Atrial Fibrillation Recurrence after Radiofrequency Catheter Procedure of Pulmonary Vein Isolation by Corticosteroids

Circulation ◽

10.1161/circ.118.suppl_18.s_772-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Takashi Koyama ◽

Yukio Sekiguchi ◽

Hiroshi Tada ◽

Takanori Arimoto ◽

Hiro Yamasaki ◽

...

Keyword(s):

Atrial Fibrillation ◽

Placebo Group ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Therapeutic Option ◽

Artery Bypass ◽

Underlying Mechanism ◽

Control Group ◽

Number Of Patients ◽

Af Recurrence

Background: Catheter based radiofrequency pulmonary vein isolation (PVI) has been shown to be an effective therapeutic option for controlling drug-refractory atrial fibrillation (AF); however, the recurrence of AF has become one of the major problems after procedure. Although the underlying mechanism of the AF recurrence is not well evaluated, previous reports indicated that inflammatory process could be associated with the onset of AF and the use of intravenous hydrocortisone reduced the incidence of AF after coronary artery bypass surgery. We therefore prospectively evaluated the efficacy of the hydrocortisone for the prevention of AF recurrence. Methods and Results: This study included consecutive 150 patients with drug-refractory paroxysmal AF. Patients were randomized to receive either hydrocortisone or matching placebos as follows: intravenous hydrocortisone (dose of 2mg/kg) was used in the day of operation, and oral hydrocortisone was administered (dose of 0.6mg/kg/day) for 3 days after PVI. Patients with non-PV-foci AF were excluded in this study (Control group; 4 patients, Hydrocortisone group; 6 patients). Various biophysical data were closely investigated between control group (n=71) and hydrocortisone group (n=69). Rate of total AF recurrence and immediate AF recurrence (recurrence of AF within 3 days after PVI) was significantly lower in hydrocortisone group than placebo group (total AF recurrence; 27.0% vs 46.1%, immediate AF recurrence; 6.7% vs 29.5%, p<0.01). Number of patients who underwent second PVI (8.3% vs 23.1%, p<0.01), rise of body temperature after the procedure (0.675°C vs 1.633°C, p=0.005), any sign of pericariditis (0% vs 6.4%, p<0.01), high sensitive CRP level after the procedure (1.17mg/dl vs 2.09mg/dl, P=0.015) and the number of patients using antiarrhythmics (classIb, classIII) after the procedure (classIb; 0% vs 6.4%, classIII; 6.7% vs 26.9%, p<0.01) were also significantly lower in hydrocortisone group than in placebo group. Conclusion: Transient use of hydrocortisone immediately after PVI can be one of the therapeutic options for the prevention of acute AF recurrence after PVI to avoid second procedure and/or the additional antiarrhythmic drug therapy.

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