TY - JOUR
T1 - Administration of isoproterenol and adenosine to guide supplemental ablation after Pulmonary Vein Antrum Isolation
AU - Elayi, Claude S.
AU - Di Biase, Luigi
AU - Bai, Rong
AU - Burkhardt, J. David
AU - Mohanty, Prasant
AU - Santangeli, Pasquale
AU - Sanchez, Javier
AU - Hongo, Richard
AU - Gallinghouse, G. Joseph
AU - Horton, Rodney
AU - Bailey, Shane
AU - Beheiry, Salwa
AU - Natale, Andrea
PY - 2013/11
Y1 - 2013/11
N2 - Administration of Isuprel/Adenosine After PulmonaryVein Antrum Isolation Background Pulmonary vein antrum isolation (PVAI) remains associated with atrial fibrillation (AF) recurrence. We administered adenosine and isoproterenol (ISP) after PVAI to uncover non-PV atrial triggers and PV reconnection, potentially increasing ablation success rate. Methods One hundred and ninety-two consecutive patients with symptomatic AF presenting for PVAI were prospectively studied (group 1). Following PVAI, adenosine (18-24 mg) and ISP (20-30 mcg/min) were administered intravenously. Supplemental ablation was performed in patients with non-PV triggers that induced AF (group 1A). Other subgroups included patients with (group 1B) or without (group 1C) consistent non-PV atrial foci that did not induce AF. A cohort of 196 matched control patients undergoing PVAI without drug challenge was used for comparison (group 2). Results A total of 132 atrial non-PV foci were revealed (31 inducing AF). The majority of atrial foci were observed with ISP (113/132, 86%). Less than 5% of patients had persistent PV recovery during the drug challenge. During a mean follow-up of 22 ± 8 months, PVAI was successful in 110/192 (57%, group 1) versus 100/196 (52%, group 2), P = 0.038. Furthermore, the success rate was statistically different between group 1A (25/32, 78%), group 1B (28/83, 34%), and group 1C (57/74, 74%), P < 0.001. Conclusion After PVAI, ablation guided by the administration of adenosine and ISP to target non-PV triggers inducing AF increased AF ablation outcomes. Patients with non-PV foci that did not induce AF had no further ablation, with the lowest ablation success rate. This group may likely benefit from further ablation after PVAI.
AB - Administration of Isuprel/Adenosine After PulmonaryVein Antrum Isolation Background Pulmonary vein antrum isolation (PVAI) remains associated with atrial fibrillation (AF) recurrence. We administered adenosine and isoproterenol (ISP) after PVAI to uncover non-PV atrial triggers and PV reconnection, potentially increasing ablation success rate. Methods One hundred and ninety-two consecutive patients with symptomatic AF presenting for PVAI were prospectively studied (group 1). Following PVAI, adenosine (18-24 mg) and ISP (20-30 mcg/min) were administered intravenously. Supplemental ablation was performed in patients with non-PV triggers that induced AF (group 1A). Other subgroups included patients with (group 1B) or without (group 1C) consistent non-PV atrial foci that did not induce AF. A cohort of 196 matched control patients undergoing PVAI without drug challenge was used for comparison (group 2). Results A total of 132 atrial non-PV foci were revealed (31 inducing AF). The majority of atrial foci were observed with ISP (113/132, 86%). Less than 5% of patients had persistent PV recovery during the drug challenge. During a mean follow-up of 22 ± 8 months, PVAI was successful in 110/192 (57%, group 1) versus 100/196 (52%, group 2), P = 0.038. Furthermore, the success rate was statistically different between group 1A (25/32, 78%), group 1B (28/83, 34%), and group 1C (57/74, 74%), P < 0.001. Conclusion After PVAI, ablation guided by the administration of adenosine and ISP to target non-PV triggers inducing AF increased AF ablation outcomes. Patients with non-PV foci that did not induce AF had no further ablation, with the lowest ablation success rate. This group may likely benefit from further ablation after PVAI.
KW - adenosine
KW - atrial fibrillation
KW - catheter ablation
KW - isoproterenol
KW - pulmonary vein isolation
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U2 - 10.1111/jce.12252
DO - 10.1111/jce.12252
M3 - Article
C2 - 24020649
AN - SCOPUS:84886778762
SN - 1045-3873
VL - 24
SP - 1199
EP - 1206
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 11
ER -