Role of immunosuppressive therapy in the management refractory postprocedural pericarditis

Bharat Narasimhan, Mohit K. Turagam, Jalaj Garg, Domenico G. Della Rocca, Rakesh Gopinathannair, Luigi Di Biase, Jorge Romero, Sanghamitra Mohanty, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: To assess the safety and efficacy of a novel immunosuppressive regimen—combination Methotrexate/Prednisone (cMtx/P)—in the management of severe refractory rPPP. Methods: In this multicenter, nonrandomized, retrospective, observational study, 408 consecutive patients diagnosed with persistent rPPP between 2017 and 19 were included. Patients with refractory symptoms despite 3 months of conventional therapy were initiated on a 4-week regimen of oral steroids. Persistence of symptoms at this point, that is, rPPP (n = 25; catheter based = 18, open surgical = 7) prompted therapy with Methotrexate (7.5–15 mg weekly) with folate supplementation along with low dose prednisone (5 mg PO) for a further 3 months. Patients were followed for a total of 11.3 ± 1.8 months. Results: Treatment refractory rPPP occurred in 6.1% of the study population prompting immunosuppressive therapy with cMtx/P. All patients demonstrated complete symptom resolution following 3 months of treatment with an 85% decline in clinically significant pericardial effusions. One patient developed recurrent pericarditis during the 11-month follow-up. Therapy was well tolerated with no significant drug related adverse effects. Conclusion: cMtx/P therapy is a safe and effective adjunct in the management of rPPP refractory to standard therapy.

Original languageEnglish (US)
Pages (from-to)2165-2170
Number of pages6
JournalJournal of cardiovascular electrophysiology
Issue number8
StatePublished - Aug 2021


  • immunosuppression
  • methotrexate
  • pericarditis
  • postablation
  • postprocedure
  • refractory
  • steroids

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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