Does adenosine testing after second-generation cryoballoon ablation improve clinical success rate for paroxysmal atrial fibrillation?

Abstract

Adenosine administration after pulmonary vein (PV) isolation using radiofrequency, can unmask PVs dormant conductions and predict atrial fibrillation (AF) recurrence. Our study evaluates whether adenosine-guided pulmonary vein isolation following second-generation cryoballoon (CB-2G) ablation may improve the success rate for paroxysmal AF. One hundred and one consecutive patients scheduled for a first ablation with (CB-2G) were prospectively included between January 2013 and November 2015 in two centers. Intravenous adenosine was administered after PV isolation to unmask dormant conductions (DC) in the first 51 patients and additional applications were performed to ablate DC. The 50 next patients underwent cryoablation without adenosine testing. Symptomatic atrial fibrillation recurrence was evaluated after 3, and 12 months. Acute PV isolation was achieved in all 402 PVs of 101 patients. Moreover, 8/204 VPPV (3,9%) involving 11,7% of patients with adenosine testing showed dormant reconduction, including 1 left superior pulmonary vein, 3 left inferior pulmonary vein, 4 right superior pulmonary vein, and no right inferior pulmonary vein. After a single procedure, success rates for cryoablation were 78,5% in adenosine group and 70% in the group without adenosine ( P = 0.22), with a mean follow-up of 422 days. Mean procedure duration for adenosine and without adenosine group were respectively 151 and 117 minutes ( P = 0.0009), and mean fluroscopy time 36 and 33 minutes ( P = 0.3). Adenosine testing after second-generation cryoballoon ablation can unmask a low rate of DC but does not improve success rate. However, this strategy increases procedural time.