title: Administration of isoproterenol and adenosine to guide supplemental ablation after pulmonary vein antrum isolation.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Javier
authors.initials: J
authors.lastname: Sanchez
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.forename: G Joseph
authors.initials: GJ
authors.lastname: Gallinghouse
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: Shane
authors.initials: S
authors.lastname: Bailey
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D004334:Drug Administration Schedule; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007545:Isoproterenol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013781:Texas; D016896:Treatment Outcome
chemical_list: D000241:Adenosine; D007545:Isoproterenol
keywords: adenosine; atrial fibrillation; catheter ablation; isoproterenol; pulmonary vein isolation