Key result
Post-PVI isoproterenol reveals persistent dormant conduction in 13% of patients and triggers non-PV foci.
Why the study?
Postoperative recurrence after catheter ablation for AF is driven by pulmonary vein reconduction and non-PV foci. This study evaluated the acute efficacy of high-dose isoproterenol added to adenosine to elucidate dormant conduction, confirm PV substrates, and induce non-PV foci.
Does isoproterenol administered after adenosine identify dormant conduction and arrhythmogenic foci in patients undergoing atrial fibrillation ablation?
Observational (n=100)
No
Does isoproterenol administered after adenosine identify dormant conduction and arrhythmogenic foci in patients undergoing atrial fibrillation ablation?
The addition of high-dose isoproterenol to adenosine after pulmonary vein isolation is useful for identifying persistent dormant conduction and non-pulmonary vein arrhythmogenic foci.
Answers are grounded in this paper and cite their sources.
May complement adenosine testing post-PVI; leaves open whether routine use improves ablation outcomes.
BACKGROUND: Catheter ablation for atrial fibrillation (AF) is an established therapy. However, postoperative recurrence is a serious issue caused by the reconduction of the isolated pulmonary veins (PV) and the onset of non-PV foci. The objectives of this study were to elucidate dormant conduction, confirm PV arrhythmia substrate, induce non-PV foci after PV isolation, and assess the acute efficacy of high dose isoproterenol (ISP) when administered in addition to adenosine. METHODS: The study consisted of 100 patients with drug-refractory AF (paroxysmal and persistent) who underwent ablation therapy (either radio-frequency or cryoballoon ablation) as the first-line of therapy at our hospital. All patients first underwent PV isolation (PVI) and were administered adenosine followed by ISP (6 μg × 5 min). The effects were observed, and the therapeutic strategy was evaluated. RESULTS: Persistent dormant conduction due to ISP administration was observed in 13 patients. In over half of the patients, arrhythmia substrates were identified in the PV. Ten patients presented with persistent PV firing. The ablation of non-PV foci was additionally performed in 23 patients. CONCLUSIONS: We found that dormant conduction, as a result of ISP administration, is persistent and ISP is useful when performing an ablation. In addition, ISP administration is useful for the identification of PV arrhythmia substrates and induction of non-PV foci. However, the effectiveness of ISP may be partially due to the complementary effect of adenosine, and, therefore, a combination of the two drugs seems preferable.
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Sakamoto et al. (2020) conducted an observational in Drug-refractory atrial fibrillation (paroxysmal or persistent) (n=100). Isoproterenol (ISP) in addition to adenosine vs. Adenosine alone was evaluated on Persistent dormant conduction. Isoproterenol administration following pulmonary vein isolation revealed persistent dormant conduction in 13% of patients and induced non-pulmonary vein foci in 23%, complementing adenosine.
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