Key result
Isoproterenol infusion during catheter ablation of atrial fibrillation was not associated with a reduction in the recurrence of atrial arrhythmias (adjusted HR 0.92).
Why the study?
High-dose isoproterenol infusion can elicit triggers during AF ablation, but whether its use after ablation is associated with differential outcomes was unknown.
Does isoproterenol infusion during catheter ablation reduce recurrence of atrial arrhythmias in patients undergoing de novo radiofrequency catheter ablation of atrial fibrillation?
Cohort (n=314)
No
Does isoproterenol infusion during catheter ablation reduce recurrence of atrial arrhythmias in patients undergoing de novo radiofrequency catheter ablation of atrial fibrillation?
Hazard Ratio: 0.92 (95% CI 0.58–1.46)
Absolute Event Rate: 49.4% vs 51.9%
p-value: p=0.714
The routine use of isoproterenol infusion to elicit triggers during de novo atrial fibrillation ablation is safe but does not significantly improve freedom from atrial arrhythmias.
Does not support routine isoproterenol in de novo AF ablation; leaves open need for randomized confirmation.
BACKGROUND: High-dose isoproterenol infusion is a useful provocative maneuver to elicit triggers of atrial fibrillation (AF) during ablation. We evaluated whether the use of isoproterenol infusion to elicit triggers of AF after ablation is associated with differential outcomes. METHODS: We performed a retrospective study of all patients who underwent de novo radiofrequency catheter ablation of AF enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AAD). RESULTS: Of 314 patients undergoing AF ablation, 235 (74.8%) received isoproterenol while 79 (25.2%) did not. Among those who received isoproterenol, 11 (4.7%) had additional triggers identified. There were no statistically significant differences in procedure time (p = 0.432), antiarrhythmic drug use (p = 0.289), procedural complications (p = 0.279), recurrences of atrial arrhythmias on or off AAD [adjusted hazard ratio (AHR) 0.92 (95% CI 0.58-1.46); p = 0.714], all-cause hospitalizations [AHR 1.00 (95% CI 0.60-1.67); p = 0.986], or all-cause mortality [AHR 0.14 (95% CI 0.01-3.52); p = 0.229] between groups. CONCLUSIONS: In this registry analysis, use of isoproterenol is safe but was not associated with a reduction in recurrence of atrial arrhythmias.
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Aldaas et al. (2022) conducted a cohort in Atrial fibrillation (n=314). Isoproterenol infusion vs. No isoproterenol infusion was evaluated on Recurrence of atrial arrhythmias on or off antiarrhythmic drugs (AHR 0.92, 95% CI 0.58-1.46, p=0.714). Isoproterenol infusion during catheter ablation of atrial fibrillation was not associated with a reduction in the recurrence of atrial arrhythmias (adjusted HR 0.92).
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