Long-term outcome of adenosine-induced atrial fibrillation after atrial fibrillation ablation: A propensity score matching analysis.

Abstract

Nonpulmonary vein (non-PV) foci, in addition to pulmonary vein (PV), are considered important in initiating atrial fibrillation (AF). This study investigates the adenosine triphosphate (ATP) as a method for inducing non-PV ectopy. The study cohort consisted of 1388 patients with AF (728 with paroxysmal AF, 650 with nonparoxysmal AF) who underwent catheter ablation. To confirm dormant PV conductions and non-PV foci, 20 or 40mg ATP was administered intravenously at the end of the procedure. The ATP test induced AF in 36 of 1388 (2.6%) patients, in whom two (6%) had ectopy arising from the both atria, 15 (42%) from the right atrium (RA), and five (14%) from left atrium (LA). Because of a lack of reproducibility, the accurate location of non-PV foci was unidentified in the remaining 11 (31%) patients. Additional radiofrequency ablation to non-PV foci induced ATP administration was not performed in 34 patients. Among all 1388 patients, 64 were assigned to the ATP-AF(+) and ATP-AF(-) groups using a propensity score matching analysis (32 patients in each group). During the follow-up period, recurrent AF was observed in 9 of 32 (28%) patients in the ATP-AF(+) group and in 10 of 32 (31%) patients in the ATP-AF(-) group (log-rank p=.84, hazard ratio 0.91 [95% confidence interval 0.36-2.27]). In the univariate analysis, AF induction by ATP test was not predictive of AF recurrence (p=.78). ATP-induced AF was not associated with AF recurrence in the distant period.