[Inducibility of atrial arrhythmias after adenosine and isoproterenol infusion in patients referred for atrial fibrillation ablation].
OBJECTIVE
The identification and ablation of atrial ectopic foci could complement the conventional empirical pulmonary vein approach and may increase the success rate of atrial fibrillation ablation. Although both adenosine and isoproterenol infusion have been reported to induce ectopics, no clear findings on their use during ablation have been published. Our aim was to investigate the utility of these two pharmacologic maneuvers in patients referred for atrial fibrillation ablation.


METHODS
The effects of adenosine infusion, isoproterenol infusion, or both were evaluated in 53 patients with refractory atrial fibrillation referred for ablation. Patients were in sinus rhythm during evaluation.


RESULTS
Administration of adenosine or isoproterenol induced atrial arrhythmias in 46 patients (87%). Arrhythmia inducibility was similar in those with paroxysmal and those with persistent atrial fibrillation (87% and 86%, respectively). Atrial ectopics alone were induced in 31 patients (65%), atrial tachycardia in four (8%), and atrial fibrillation in 13 (27%). In 10 patients (19%), ectopic foci were located outside the pulmonary veins and subsequently underwent ablation. In 32 of the 46 patients with inducible arrhythmias, only the induced ectopic foci were ablated (mean 1.4 [0.6] targets per patient). The long-term success rate of first procedures was 66%.


CONCLUSIONS
Adenosine and isoproterenol infusion induced atrial ectopics in most patients with drug-refractory atrial fibrillation while they were in sinus rhythm. In almost 20%, the ectopic foci were located outside the pulmonary veins. The effectiveness of induced ectopic-guided ablation observed in our patient series supports the clinical utility of this approach.
Isa-Param
Rodrigo
R
Unidad de Arritmias, Instituto Cardiovascular, Hospital Clínico San Carlos, Prof. Martin Lagos s/n, 28040 Madrid, Spain.
Pérez-Castellano
Nicasio
N
Villacastín
Julián
J
Moreno
Javier
J
Salinas
Jorge
J
Alonso
Rafael
R
Ruiz
Eduardo
E
Doblado
Manuel
M
Morales
Ricardo
R
Macaya
Carlos
C
D000241:Adenosine / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D003627:Data Interpretation, Statistical; D004594:Electrophysiology; D005500:Follow-Up Studies; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D000241:Adenosine; D007545:Isoproterenol