Intrapericardial Corticosteroids and Colchicine Prevent Pericarditis and Atrial Fibrillation After Epicardial Ablation of Ventricular Arrhythmias

Abstract

Background: Postprocedural pericarditis (PP) can occur in up to 29.4% of patients undergoing epicardial catheter ablation of ventricular tachycardia (VT). Despite several proposed strategies to mitigate this adverse outcome, rates of PP and pericarditic pain remain high.

Objectives: This study sought to assess the impact of intrapericardial steroids instillation (ISI) combined with periprocedural colchicine on PP after epicardial VT ablation.

Methods: This prospective multicenter study included patients undergoing epicardial VT ablation between June 2021 and December 2023. The primary outcome was the occurrence of pericarditis, defined as the presence of pericarditic chest pain and pericarditic electrocardiographic (ECG) changes. Secondary outcomes included the pericarditic pain score at 6, 12, 24, and 48 hours after the procedure, pericardial effusion, postprocedural new-onset atrial fibrillation (AF), constrictive pericarditis, admission due to pericarditis, and gastrointestinal side effects. A systematic literature search was performed to identify historical control groups to compare with our cohort.

Results: A total of 129 patients underwent epicardial VT ablation with subsequent ISI and colchicine therapy. The combination of ISI and colchicine resulted in a nonsignificant trend of lower rates of pericarditis when compared with all historical control groups (3.1% [4 of 129] vs 7.0% [12 of 172]; P = 0.109) and a significant difference when compared to intrapericardial steroids (3.1% vs 13.2%; P = 0.030). The rates of pericarditic pain (10.9% [14 of 129] vs 30.9% [21 of 68]; P = 0.001), pericarditic ECG changes (5.4% [7 of 129] vs 33.8% [23 of 68]; P < 0.001) and new-onset atrial fibrillation (0.8% vs 19.5%; P = <0.001) were significantly lower in our study than in historical control groups.

Conclusions: The instillation of intrapericardial steroids along with periprocedural colchicine after epicardial VT ablation led to a decreased incidence of adverse effects associated with pericardial inflammation when compared with historical control groups. Further research with contemporary control groups is needed to confirm the suggested impact of the strategy described here.

Keywords: cardiac arrhythmias; catheter ablation; epicardial access; quality improvement; radiofrequency ablation; ventricular arrhythmias.