What question did this study set out to answer?

To evaluate if routine adenosine challenge improves long-term outcomes in patients undergoing posterior left atrial wall isolation for persistent atrial fibrillation.

February 15, 2017EP EuropaceOpen Access

Isolation of the posterior left atrium for patients with persistent atrial fibrillation: routine adenosine challenge for dormant posterior left atrial conduction improves long-term outcome

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Persistent atrial fibrillation (n=161). Intervention: Routine adenosine challenge vs. No adenosine challenge. Primary outcome: Single procedure freedom from recurrent atrial arrhythmia (p=<0.01).

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Key result

Routine adenosine challenge for dormant posterior wall conduction during catheter ablation for persistent AF improved single-procedure freedom from recurrent atrial arrhythmia (65% vs 40%, P<0.01).

Why the study?

Does routine adenosine challenge for dormant posterior wall conduction improve freedom from recurrent atrial arrhythmia in patients with persistent AF undergoing catheter ablation?

Key Points

To evaluate if routine adenosine challenge improves long-term outcomes in patients undergoing posterior left atrial wall isolation for persistent atrial fibrillation.
161 patients with persistent atrial fibrillation underwent catheter ablation with pulmonary vein isolation and posterior wall isolation.
Adenosine 15 mg was administered to assess reconnection of pulmonary veins and posterior wall, with ablation of transient reconnections performed as needed.
Holter monitoring at 6 and 12 months was used to track arrhythmia recurrence.
Successful posterior left atrial wall isolation achieved in 91% of patients.
Single procedure freedom from recurrent atrial arrhythmia was 65% in the adenosine challenge group vs. 40% without (P < 0.01).
After multiple procedures, freedom from atrial fibrillation was 85% in the adenosine group vs. 65% without (P = 0.01).

Study Design

Type

Cohort (n=161)

Structured PICO

Does routine adenosine challenge for dormant posterior wall conduction improve freedom from recurrent atrial arrhythmia in patients with persistent AF undergoing catheter ablation?

Population

161 patients with persistent atrial fibrillation (mean age 59 ± 9 years, AF duration 6 ± 5 years) undergoing catheter ablation involving circumferential pulmonary vein isolation followed by posterior left atrial wall isolation.

Intervention

Routine adenosine challenge (15 mg sequentially administered) to assess and ablate dormant posterior wall and pulmonary vein conduction.

Comparator

No adenosine challenge during ablation.

Outcome

Single procedure freedom from recurrent atrial arrhythmia at mean follow-up of 19 ± 8 months (assessed by Holter monitoring at 6 and 12 months).surrogate

Main Result

Absolute Event Rate: 65% vs 40%

p-value: p=<0.01

Routine adenosine challenge to identify and ablate dormant posterior wall conduction significantly improves long-term freedom from atrial arrhythmias in patients with persistent AF.

Discussion

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Implication

May support adenosine challenge in persistent AF ablation; leaves open randomized confirmation before practice change.

Cite This Study

McLellan et al. (2017) conducted a cohort in Persistent atrial fibrillation (n=161). Routine adenosine challenge vs. No adenosine challenge was evaluated on Single procedure freedom from recurrent atrial arrhythmia (p=<0.01). Routine adenosine challenge for dormant posterior wall conduction during catheter ablation for persistent AF improved single-procedure freedom from recurrent atrial arrhythmia (65% vs 40%, P<0.01).

synapsesocial.com/papers/6a11de3e26b419a984b4dc9d https://doi.org/10.1093/europace/euw231

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Isolation of the posterior left atrium for patients with persistent atrial fibrillation: routine adenosine challenge for dormant posterior left atrial conduction improves long-term outcome

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Isolation of the posterior left atrium for patients with persistent atrial fibrillation: routine adenosine challenge for dormant posterior left atrial conduction improves long-term outcome

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider