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