Administration of Isoproterenol and Adenosine to Guide Supplemental Ablation After Pulmonary Vein Antrum Isolation


  • 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 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.