Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial

Publication date: Available online 23 July 2015 Source:The Lancet Author(s): Laurent Macle, Paul Khairy, Rukshen Weerasooriya, Paul Novak, Atul Verma, Stephan Willems, Thomas Arentz, Isabel Deisenhofer, George Veenhuyzen, Christophe Scavée, Pierre Jaïs, Helmut Puererfellner, Sylvie Levesque, Jason G Andrade, Lena Rivard, Peter G Guerra, Marc Dubuc, Bernard Thibault, Mario Talajic, Denis Roy, Stanley Nattel Background Catheter ablation is increasingly used to manage atrial fibrillation, but arrhythmia recurrences are common. Adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve arrhythmia-free survival. We assessed whether adenosine-guided pulmonary vein isolation could prevent arrhythmia recurrence in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation. Methods We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled patients aged older than 18 years who had had at least three symptomatic atrial fibrillation episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned (1:1) to additional adenosine-guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction w...
Source: The Lancet - Category: Journals (General) Source Type: research