title: Adenosine triphosphate-guided pulmonary vein isolation for atrial fibrillation: the UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate (UNDER-ATP) trial.
abstract: OBJECTIVE
  Most of recurrent atrial tachyarrhythmias after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are due to reconnection of PVs. The aim of the present study was to evaluate whether elimination of adenosine triphosphate (ATP)-induced dormant PV conduction by additional energy applications during the first ablation procedure could reduce the incidence of recurrent atrial tachyarrhythmias.
  
  
  RESULTS
  We randomly assigned 2113 patients with paroxysmal, persistent, or long-lasting AF to either ATP-guided PVI (1112 patients) or conventional PVI (1001 patients). The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of Vaughan Williams class I or III antiarrhythmic drugs at 1 year with the blanking period of 90 days post ablation. Among patients assigned to ATP-guided PVI, 0.4 mg/kg body weight of ATP provoked dormant PV conduction in 307 patients (27.6%). Additional radiofrequency energy applications successfully eliminated dormant conduction in 302 patients (98.4%). At 1 year, 68.7% of patients in the ATP-guided PVI group and 67.1% of patients in the conventional PVI group were free from the primary endpoint, with no significant difference (adjusted hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.74-1.09; P = 0.25). The results were consistent across all the prespecified subgroups. Also, there was no significant difference in the 1-year event-free rates from repeat ablation for any atrial tachyarrhythmia between the groups (adjusted HR 0.83; 95% CI 0.65-1.08; P = 0.16).
  
  
  CONCLUSIONS
  In the catheter ablation for AF, we found no significant reduction in the 1-year incidence of recurrent atrial tachyarrhythmias by ATP-guided PVI compared with conventional PVI.
authors: Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors: Atsushi
authors: A
authors: Kobori
authors: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan shizuta@kuhp.kyoto-u.ac.jp.
authors: Satoshi
authors: S
authors: Shizuta
authors: Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
authors: Koichi
authors: K
authors: Inoue
authors: Division of Cardiology, Tenri Hospital, Tenri, Japan.
authors: Kazuaki
authors: K
authors: Kaitani
authors: Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan.
authors: Takeshi
authors: T
authors: Morimoto
authors: Heart Rhythm Center, Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
authors: Yuko
authors: Y
authors: Nakazawa
authors: Heart Rhythm Center, Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
authors: Tomoya
authors: T
authors: Ozawa
authors: Cardiovascular Center, Shiroyama Hospital, Habikino City, Osaka, Japan.
authors: Toshiya
authors: T
authors: Kurotobi
authors: Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
authors: Itsuro
authors: I
authors: Morishima
authors: Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
authors: Fumiharu
authors: F
authors: Miura
authors: Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan.
authors: Tetsuya
authors: T
authors: Watanabe
authors: Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan.
authors: Masaharu
authors: M
authors: Masuda
authors: Department of Cardiovascular Medicine, Nara Prefecture Western Medical Center, Nara, Japan.
authors: Masaki
authors: M
authors: Naito
authors: Department of Cardiovascular Medicine, Nara Prefecture Western Medical Center, Nara, Japan.
authors: Hajime
authors: H
authors: Fujimoto
authors: First Department of Internal Medicine, Nara Medical University, Nara, Japan.
authors: Taku
authors: T
authors: Nishida
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Yoshio
authors: Y
authors: Furukawa
authors: Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Takeshi
authors: T
authors: Shirayama
authors: Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors: Mariko
authors: M
authors: Tanaka
authors: Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan.
authors: Katsunori
authors: K
authors: Okajima
authors: Department of Cardiovascular Medicine, Okamura Memorial Hospital, Shizuoka, Japan.
authors: Takenori
authors: T
authors: Yao
authors: Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
authors: Yasuyuki
authors: Y
authors: Egami
authors: Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Kazuhiro
authors: K
authors: Satomi
authors: Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Takashi
authors: T
authors: Noda
authors: Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Koji
authors: K
authors: Miyamoto
authors: Cardiovascular Center, Tazuke Medical Research Institute Kitano Hospital, Osaka, Japan.
authors: Tetsuya
authors: T
authors: Haruna
authors: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors: Tetsuma
authors: T
authors: Kawaji
authors: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors: Takashi
authors: T
authors: Yoshizawa
authors: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors: Toshiaki
authors: T
authors: Toyota
authors: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors: Mitsuhiko
authors: M
authors: Yahata
authors: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors: Kentaro
authors: K
authors: Nakai
authors: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors: Hiroaki
authors: H
authors: Sugiyama
authors: Department of Cardiovascular Medicine, Okamura Memorial Hospital, Shizuoka, Japan.
authors: Yukei
authors: Y
authors: Higashi
authors: Heart Rhythm Center, Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
authors: Makoto
authors: M
authors: Ito
authors: Heart Rhythm Center, Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
authors: Minoru
authors: M
authors: Horie
authors: Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Kengo F
authors: KF
authors: Kusano
authors: Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors: Wataru
authors: W
authors: Shimizu
authors: Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Shiro
authors: S
authors: Kamakura
authors: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors: Takeshi
authors: T
authors: Kimura
mesh_terms: D000255:Adenosine Triphosphate; D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D055502:Secondary Prevention; D013610:Tachycardia / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000255:Adenosine Triphosphate
keywords: Adenosine; Atrial fibrillation; Catheter ablation; Dormant conduction; Pulmonary vein isolation