Administration of isoproterenol and adenosine to guide supplemental ablation after Pulmonary Vein Antrum Isolation

Claude S. Elayi, Luigi Di Biase, Rong Bai, J. David Burkhardt, Prasant Mohanty, Pasquale Santangeli, Javier Sanchez, Richard Hongo, G. Joseph Gallinghouse, Rodney Horton, Shane Bailey, Salwa Beheiry, Andrea Natale

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1199-1206
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume24
Issue number11
DOIs
StatePublished - Nov 2013
Externally publishedYes

Fingerprint

Pulmonary Veins
Isoproterenol
Adenosine
Atrial Fibrillation
Pharmaceutical Preparations
Recurrence

Keywords

  • adenosine
  • atrial fibrillation
  • catheter ablation
  • isoproterenol
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Administration of isoproterenol and adenosine to guide supplemental ablation after Pulmonary Vein Antrum Isolation. / Elayi, Claude S.; Di Biase, Luigi; Bai, Rong; Burkhardt, J. David; Mohanty, Prasant; Santangeli, Pasquale; Sanchez, Javier; Hongo, Richard; Gallinghouse, G. Joseph; Horton, Rodney; Bailey, Shane; Beheiry, Salwa; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 24, No. 11, 11.2013, p. 1199-1206.

Research output: Contribution to journalArticle

Elayi, CS, Di Biase, L, Bai, R, Burkhardt, JD, Mohanty, P, Santangeli, P, Sanchez, J, Hongo, R, Gallinghouse, GJ, Horton, R, Bailey, S, Beheiry, S & Natale, A 2013, 'Administration of isoproterenol and adenosine to guide supplemental ablation after Pulmonary Vein Antrum Isolation', Journal of Cardiovascular Electrophysiology, vol. 24, no. 11, pp. 1199-1206. https://doi.org/10.1111/jce.12252
Elayi, Claude S. ; Di Biase, Luigi ; Bai, Rong ; Burkhardt, J. David ; Mohanty, Prasant ; Santangeli, Pasquale ; Sanchez, Javier ; Hongo, Richard ; Gallinghouse, G. Joseph ; Horton, Rodney ; Bailey, Shane ; Beheiry, Salwa ; Natale, Andrea. / Administration of isoproterenol and adenosine to guide supplemental ablation after Pulmonary Vein Antrum Isolation. In: Journal of Cardiovascular Electrophysiology. 2013 ; Vol. 24, No. 11. pp. 1199-1206.
@article{aaa55ff0cfd7464fb14192688aacb495,
title = "Administration of isoproterenol and adenosine to guide supplemental ablation after Pulmonary Vein Antrum Isolation",
abstract = "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.",
keywords = "adenosine, atrial fibrillation, catheter ablation, isoproterenol, pulmonary vein isolation",
author = "Elayi, {Claude S.} and {Di Biase}, Luigi and Rong Bai and Burkhardt, {J. David} and Prasant Mohanty and Pasquale Santangeli and Javier Sanchez and Richard Hongo and Gallinghouse, {G. Joseph} and Rodney Horton and Shane Bailey and Salwa Beheiry and Andrea Natale",
year = "2013",
month = "11",
doi = "10.1111/jce.12252",
language = "English (US)",
volume = "24",
pages = "1199--1206",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",
number = "11",

}

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

UR - http://www.scopus.com/inward/record.url?scp=84886778762&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886778762&partnerID=8YFLogxK

U2 - 10.1111/jce.12252

DO - 10.1111/jce.12252

M3 - Article

C2 - 24020649

AN - SCOPUS:84886778762

VL - 24

SP - 1199

EP - 1206

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - 11

ER -