Association of isoproterenol infusion during catheter ablation of atrial fibrillation with outcomes: insights from the UC San Diego AF Ablation Registry

Abstract

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.

Impact of Atrial Fibrillation Triggers on Long-Term Outcomes of a Second Catheter Ablation of Nonparoxysmal Atrial Fibrillation

“…ISP is used to assess AF triggers because it has >80% success rate in provoking PV and non-PV AF triggers. 16 Although adenosine triphosphate (ATP) is effective in inducing AF, we did not use it to induce AF in this study. It should be noted that the effects of ISP are not the same as the effects of ATP.…”

Response to Letter to the Editor

“…We thank Kataoka et al for their comments regarding our recently published article on catheter ablation of atrial fibrillation in very elderly patients (≥80 years old). 1 While the unadjusted time‐to‐event analysis may be more reflective of real‐world clinical practice, we adjusted for multiple potential confounders to more clearly assess the association of catheter ablation with all‐cause hospitalizations and mortality in the very elderly. All of the patients included in the study underwent radiofrequency ablation.…”