Administration of Isoproterenol and Adenosine to Guide Supplemental Ablation After Pulmonary Vein Antrum Isolation

作者：Elayi Claude S; Di Biase Luigi; Bai Rong; Burkhardt J David; Mohanty Prasant; Santangeli Pasquale; Sanchez Javier; Hongo Richard; Gallinghouse G Joseph; Horton Rodney; Bailey Shane; Beheiry Salwa; Natale Andrea^*

来源：Journal of Cardiovascular Electrophysiology, 2013, 24(11): 1199-1206.

DOI：10.1111/jce.12252

• adenosine
• atrial fibrillation
• catheter ablation
• isoproterenol
• pulmonary vein isolation

Administration of Isuprel/Adenosine After PulmonaryVein Antrum Isolation %26lt;br%26gt;BackgroundPulmonary 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. %26lt;br%26gt;MethodsOne 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). %26lt;br%26gt;ResultsA 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 %26lt; 0.001. %26lt;br%26gt;ConclusionAfter 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.

• 出版日期2013-11