Response to Letter by Chhabra and Spodick Regarding Article, “Influence of Steroid Therapy on the Incidence of Pericarditis and Atrial Fibrillation Following Percutaneous Epicardial Mapping and Ablation for Ventricular Tachycardia” by Dyrda et al
2014; Lippincott Williams & Wilkins; Volume: 7; Issue: 5 Linguagem: Inglês
10.1161/circep.114.002249
ISSN1941-3149
AutoresKatia Dyrda, Sebastiaan R.D. Piers, Carine F. van Huls van Taxis, Martin J. Schalij, Katja Zeppenfeld,
Tópico(s)Cardiac Arrhythmias and Treatments
ResumoHomeCirculation: Arrhythmia and ElectrophysiologyVol. 7, No. 5Response to Letter by Chhabra and Spodick Regarding Article, "Influence of Steroid Therapy on the Incidence of Pericarditis and Atrial Fibrillation Following Percutaneous Epicardial Mapping and Ablation for Ventricular Tachycardia" by Dyrda et al Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter by Chhabra and Spodick Regarding Article, "Influence of Steroid Therapy on the Incidence of Pericarditis and Atrial Fibrillation Following Percutaneous Epicardial Mapping and Ablation for Ventricular Tachycardia" by Dyrda et al Katia Dyrda, MD, MSc, Sebastiaan R.D. Piers, MD, Carine F. van Huls van Taxis, MD, Martin J. Schalij, MD, PhD and Katja Zeppenfeld, MD, PhD Katia DyrdaKatia Dyrda Leiden University Medical Center, Leiden, The Netherlands , Sebastiaan R.D. PiersSebastiaan R.D. Piers Leiden University Medical Center, Leiden, The Netherlands , Carine F. van Huls van TaxisCarine F. van Huls van Taxis Leiden University Medical Center, Leiden, The Netherlands , Martin J. SchalijMartin J. Schalij Leiden University Medical Center, Leiden, The Netherlands and Katja ZeppenfeldKatja Zeppenfeld Leiden University Medical Center, Leiden, The Netherlands Originally published1 Oct 2014https://doi.org/10.1161/CIRCEP.114.002249Circulation: Arrhythmia and Electrophysiology. 2014;7:992We thank Drs Chhabra and Spodick for their interest in our publication.1 Indeed they raise interesting questions for which we provide some answers in the following paragraphs.We do think there may be important differences in the mechanism of post ablation pericarditis and of idiopathic pericarditis and thereby for recurrences also. For example, recurrences are highly common in idiopathic pericarditis (10%–30%),2 but occurred in only 1 of 85 patients (1%) in the present study.Two additional diagnostic criteria for pericarditis are mentioned by Drs Chhabra and Spodick, namely, pericardial effusion on echocardiography and pericardial rub. We think these criteria are not as valuable in this context as there is always some amount of fluid on echo after epicardial ventricular tachycardia ablation, and a pigtail catheter is left in situ in the pericardial space. In addition, much care was taken to distinguish between pain at the postoperative site (entry point of the pigtail catheter) and pericarditic pain. As we do not puncture the pleura, there is no reason for truly pleuritic pain.Although we recognize the value of controlled trials, there were few patients with new-onset atrial fibrillation, and we thus opted to be careful with our conclusions. We fully agree that the presence of underlying structural heart disease may increase the likelihood of postprocedural atrial fibrillation. Of the patients with new-onset atrial fibrillation, 2 had no structural heart disease, whereas 1 had dilated cardiomyopathy and 4 had scars of unknown origin. For interest, there were 2 patients with new-onset atrial fibrillation in the no steroid group, 2 in the systemic steroid group, and 3 in the epicardial steroid group. Unfortunately, further answers can only be speculative as the numbers are too small for statistically meaningful comparison and for correction for underlying heart disease. Furthermore, the limited number of subjects precludes any subgroup analyses in patients with and without beta-blockers and with and without antiarrhythmic drugs.The higher incidence of NSAID use in patients who received intrapericardial steroids may be because of increased awareness of pericarditic chest pain after epicardial mapping in more recent patients. However, NSAIDS were generally avoided in patients with a poor ejection fraction and with renal failure, which may have contributed to the distribution of NSAID use among the treatment groups. Indeed, this is a limitation related to the observational nature of our study.Colchicine may indeed be a promising therapeutic option in patients undergoing epicardial mapping.3,4 Whether a single intrapericardial injection of triamcinolone attenuates the effect of colchicine treatment, as has been observed in patients who had received prolonged treatment with systemic steroids,5 remains uncertain. However, the single use of triamcinolone without any associated gastrointestinal side effects renders it an appealing therapeutic option.KatiaDyrda, MD, MSc*Sebastiaan R.D. Piers, MD*Carine F. van Huls van Taxis, MDMartin J. Schalij, MD, PhDKatjaZeppenfeld, MD, PhDLeiden University Medical CenterLeidenThe NetherlandsDisclosuresThe Department of Cardiology at the Leiden University Medical Centre receives unrestricted research and fellowship grants from Biotronik, Boston Scientific, GE Healthcare, Medtronic, and St. Jude Medical. K. Zeppenfeld receives consulting fees from St. Jude Medical.Footnotes*Dyrda and Piers contributed equally to this work.References1. Chhabra L, Spodick DH. Letter by Chhabra and Spodick regarding article, "Influence of steroid therapy on the incidence of pericarditis and atrial fibrillation after percutaneous epicardial mapping and ablation for ventricular tachycardia" by Dydra et al.Circ Arrhythm Electrophysiol2014; 7:991.LinkGoogle Scholar2. Maestroni S, Di Corato PR, Cumetti D, Chiara DB, Ghidoni S, Prisacaru L, Cantarini L, Imazio M, Penco S, Pedrotti P, Caforio AL, Doria A, Brucato A. Recurrent pericarditis: autoimmune or autoinflammatory?Autoimmun Rev. 2012; 12:60–65.CrossrefMedlineGoogle Scholar3. Imazio M, Brucato A, Ferrazzi P, Rovere ME, Gandino A, Cemin R, Ferrua S, Belli R, Maestroni S, Simon C, Zingarelli E, Barosi A, Sansone F, Patrini D, Vitali E, Trinchero R, Spodick DH, Adler Y; COPPS Investigators. Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy.Circulation. 2011; 124:2290–2295.LinkGoogle Scholar4. Imazio M, Brucato A, Cemin R, Ferrua S, Maggiolini S, Beqaraj F, Demarie D, Forno D, Ferro S, Maestroni S, Belli R, Trinchero R, Spodick DH, Adler Y; ICAP Investigators. A randomized trial of colchicine for acute pericarditis.N Engl J Med. 2013; 369:1522–1528.CrossrefMedlineGoogle Scholar5. Artom G, Koren-Morag N, Spodick DH, Brucato A, Guindo J, Bayes-de-Luna A, Brambilla G, Finkelstein Y, Granel B, Bayes-Genis A, Schwammenthal E, Adler Y. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis.Eur Heart J. 2005; 26:723–727.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Subramanian M, Ravilla V, Yalagudri S, Saggu D, Rangaswamy V, d'Avila A and Narasimhan C (2021) CT‐guided percutaneous epicardial access for ventricular tachycardia ablation: A proof‐of‐concept study, Journal of Cardiovascular Electrophysiology, 10.1111/jce.15210, 32:10, (2665-2672), Online publication date: 1-Oct-2021. October 2014Vol 7, Issue 5 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCEP.114.002249PMID: 25336375 Originally publishedOctober 1, 2014 PDF download Advertisement SubjectsArrhythmiasCatheter Ablation and Implantable Cardioverter-DefibrillatorElectrophysiology
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