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Adenosine after pulmonary vein isolation reveals dormant conduction, does not improve outcomes
Administering adenosine after pulmonary vein isolation revealed dormant conduction in patients with paroxysmal atrial fibrillation, but the resulting additional ablation did not improve outcomes, according to a new study.
Researchers randomly assigned 129 patients with paroxysmal AF (mean age, 59 years; 70% men) to receive adenosine or no adenosine after pulmonary vein isolation. In the adenosine group, any dormant conduction revealed was further ablated until the elimination of all such reconnections. After the procedure, both groups were given isoproterenol.
The outcome of interest was recurrence of AF. Mean follow-up was 278 days.
Hamid Ghanbari, MD, MPH, from the division of cardiovascular medicine, University of Michigan, Ann Arbor, and colleagues reported that 37% of patients in the adenosine group had dormant conduction identified after adenosine administration. The number of pulmonary veins reconnected was lower in those given adenosine more than 60 minutes after initial pulmonary vein isolation compared with those given adenosine less than 60 minutes after (9.4% vs. 75%; P < .0001), the researchers wrote.
Patients in the no-adenosine group had more pulmonary vein reconnections after infusion of isoproterenol than patients in the adenosine group (25% vs. 8.2%; P = .018), according to the results.
However, Ghanbari and colleagues found no difference in AF recurrence during the study period (adenosine group, 39%; no-adenosine group, 34%; log-rank P = .83).
Twelve patients from the adenosine group and nine from the no-adenosine group underwent repeat ablation (P = .35), and at final follow-up, 96.7% of the adenosine group and 95.6% of the no-adenosine group were free from atrial arrhythmias (P = .74).
Age was the only independent predictor of AF recurrence (HR = 1.06; 95% CI, 1.02-1.1).
According to Ghanbari and colleagues, most previous studies suggesting a benefit of additional ablation after adenosine administration were observational and may have had selection bias; that differences in results from the randomized ADVICE trial could be explained by differences in randomization; and that “it also is possible that adenosine may not be effective in identifying [pulmonary veins] that are likely to recover and contribute to recurrence.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.