Dr. Di Biase reports serving as consultant and/or on the advisory board of Biosense Webster, Hansen Medical, and St. Jude Medical. Dr. Burkhardt reports serving as a consultant to Biosense Webster. Dr. Sanchez reports compensation for participation on a speaker's bureau for St. Jude Medical, Medtronic, and Biosense Webster. Dr. Natale reports serving as consultant and/or on the advisory board of Medtronic, Biotronik, St. Jude Medical, Biosense Webster, and Boston Scientific. Other authors: No disclosures.
Administration of Isoproterenol and Adenosine to Guide Supplemental Ablation After Pulmonary Vein Antrum Isolation
Article first published online: 10 SEP 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 11, pages 1199–1206, November 2013
How to Cite
ELAYI, C. S., DI BIASE, L., BAI, R., BURKHARDT, J. D., MOHANTY, P., SANTANGELI, P., SANCHEZ, J., HONGO, R., GALLINGHOUSE, G. J., HORTON, R., BAILEY, S., BEHEIRY, S. and NATALE, A. (2013), Administration of Isoproterenol and Adenosine to Guide Supplemental Ablation After Pulmonary Vein Antrum Isolation. Journal of Cardiovascular Electrophysiology, 24: 1199–1206. doi: 10.1111/jce.12252
- Issue published online: 28 OCT 2013
- Article first published online: 10 SEP 2013
- Accepted manuscript online: 2 AUG 2013 10:28AM EST
- Manuscript Accepted: 11 JUN 2013
- Manuscript Revised: 9 JUN 2013
- Manuscript Received: 23 NOV 2012
- atrial fibrillation;
- catheter ablation;
- pulmonary vein isolation
Administration of Isuprel/Adenosine After PulmonaryVein Antrum Isolation
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.
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).
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.
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.