Adenosine triphosphate-guided pulmonary vein isolation for atrial fibrillation: the UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate (UNDER-ATP) trial

作者：Kobori Atsushi; Shizuta Satoshi^*; Inoue Koichi; Kaitani Kazuaki; Morimoto Takeshi; Nakazawa Yuko; Ozawa Tomoya; Kurotobi Toshiya; Morishima Itsuro; Miura Fumiharu; Watanabe Tetsuya; Masuda Masaharu; Naito Masaki; Fujimoto Hajime; Nishida Taku; Furukawa Yoshio; Shirayama Takeshi; Tanaka Mariko; Okajima Katsunori; Yao Takenori; Egami Yasuyuki; Satomi Kazuhiro; Noda Takashi; Miyamoto Koji; Haruna Tetsuya; Kawaji Tetsuma; Yoshizawa Takashi; Toyota Toshiaki

来源：European Heart Journal, 2015, 36(46): 3276-3287.

DOI：10.1093/eurheartj/ehv457

• Adenosine
• Atrial fibrillation
• Catheter ablation
• Dormant conduction
• Pulmonary vein isolation

Aims 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.
Methods and 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).
Conclusion 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.

• 出版日期2015-12-7