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ADVICE: Adenosine-guided pulmonary vein isolation during AF ablation safe, effective
When adenosine testing was used to identify dormant pulmonary vein conduction in patients with atrial fibrillation undergoing catheter ablation, the rate of arrhythmia-free survival increased.
Arrhythmia recurrence after catheter ablation for AF can be common. Researchers investigated whether administration of IV adenosine could identify pulmonary veins with dormant conduction, which are at risk for reconnection, and whether doing so could help patients with paroxysmal AF avoid arrhythmia recurrence, according to the study background.
The study included 534 patients with at least three symptomatic episodes of AF in the prior 6 months who were treated unsuccessfully with an antiarrhythmic drug.
All patients received IV adenosine after pulmonary vein isolation to identify dormant conduction. The researchers randomly assigned the 284 patients with dormant conduction to additional ablation guided by adenosine or to no further ablation. They randomly selected some of the patients without dormant conduction for inclusion in a registry.
Time to symptomatic atrial tachyarrythmia was the primary outcome. Follow-up was performed at 1 year.
At 1 year, 69.4% of the dormant–conduction-identified patients who received additional ablation guided by adenosine were free from symptomatic atrial tachyarrythmia, compared with 42.3% of those who did not receive additional ablation (absolute risk reduction, 27.1%; 95% CI, 15.9-38.2; P < .0001; HR = 0.44; 95% CI, 0.31-0.64), Laurent Macle, MD, from Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, department of medicine, Université de Montréal, Canada, and colleagues reported in The Lancet.
Among the 115 patients who did not have dormant conduction, 55.7% met the primary endpoint at 1 year (P vs. those who had dormant conduction without further ablation = .0191), Macle and colleagues wrote.
Serious adverse events at 1 year were similar between the groups (P = .6279), none of which were related to adenosine, the researchers wrote. There were two deaths, one from a stroke 24 days after the procedure, which was likely to have been procedure-related, and one from a stroke judged unrelated to the procedure.
The researchers concluded that using adenosine to identify dormant conduction in patients with paroxysmal AF undergoing catheter ablation “is a safe and highly effective strategy to improve arrhythmia-free survival” and “should be considered for incorporation into routine clinical practice.” – by Erik Swain
Disclosure: The study was funded in part by Biosense Webster and St. Jude Medical. Macle reports receiving lecture fees from Biosense Webster, Bristol-Myers Squibb, Pfizer and St. Jude Medical, and grant support from Biosense Webster and St. Jude Medical. See the full study for a list of the other researchers’ relevant financial disclosures.