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Background  Two methods for testing inducibility of atrial fibrillation ( AF )—atrial pacing and isoproterenol infusion—have been proposed to determine the endpoint of catheter ablation. However, the utility of the combination for testing electrophysiological inducibility ( EPI ) and pharmacological inducibility ( PHI ) is unclear.    Methods  After pulmonary vein isolation ( PVI ), inducibility of atrial tachyarrhythmia was assessed with the dual methods in 291 consecutive patients with  AF  (65% paroxysmal) undergoing initial catheter ablation.    Results  The incidence of  EPI  was significantly higher in patients with persistent  AF  than paroxysmal  AF  (32.0% vs 11.7%, respectively,  P  < .001). The incidence of  PHI  was not significantly different between the two groups (25.2% vs 26.1%, respectively,  P  = .87). There was no significant difference in  AF  recurrence according to inducibility in paroxysmal  AF . In persistent  AF , however, patients achieving neither  EPI  nor  PHI  under  PVI ‐only strategy had significantly lower rates of  AF  recurrence than those achieving either  EPI  or  PHI  and consequently requiring additional ablation for inducible atrial tachyarrhythmia (68.5% vs 49.0%, respectively; log‐rank test,  P  = .022). In persistent  AF , multivariate Cox regression analysis showed that achieving neither  EPI  nor  PHI  was a negative independent predictor of  AF  recurrence ( HR  0.492, 95%  CI  0.254‐0.916,  P  = .026).    Conclusions  Achieving neither  EPI  nor  PHI  following  PVI  was associated with favorable outcome in patients with persistent  AF . The combination of tests may discriminate patients responsive to the  PVI ‐only strategy. Further selective approaches are necessary to improve outcome for inducible atrial tachyarrhythmia in patients with persistent  AF .

journal of arrhythmia

Impact of electrophysiological and pharmacological noninducibility following pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation