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

L. Macle, P. Khairy, Hemal Weerasooriya, P. Novak, A. Verma, S. Willems, T. Arentz, I. Deisenhofer, G. Veenhuyzen, C. Scavée, P. Jaïs, H. Puererfellner, S. Levesque, J.G. Andrade, L. Rivard, P.G. Guerra, M. Dubuc, B. Thibault, M. Talajic, D. RoyS. Nattel

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    Abstract

    © 2015 Elsevier Ltd. Summary 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 was revealed, randomly selected patients were included in a registry. Patients were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. Patients were followed up for 1 year. The primary outcome was time to symptomatic atrial tachyarrhythmia after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980. Findings Adenosine unmasked dormant pulmonary vein conduction in 284 (53%) of 534 patients. 102 (69·4%) of 147 patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 58 (42·3%) of 137 patients with no further ablation, corresponding to an absolute risk reduction of 27·1% (95% CI 15·9-38·2; p
    Original languageEnglish
    Pages (from-to)672-679
    JournalThe Lancet
    Volume386
    Issue number9994
    DOIs
    Publication statusPublished - 2015

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    Macle, L., Khairy, P., Weerasooriya, H., Novak, P., Verma, A., Willems, S., Arentz, T., Deisenhofer, I., Veenhuyzen, G., Scavée, C., Jaïs, P., Puererfellner, H., Levesque, S., Andrade, J. G., Rivard, L., Guerra, P. G., Dubuc, M., Thibault, B., Talajic, M., ... Nattel, S. (2015). Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: An international, multicentre, randomised superiority trial. The Lancet, 386(9994), 672-679. https://doi.org/10.1016/S0140-6736(15)60026-5