Adenosine‐Guided Pulmonary Vein Antral Isolation for Paroxysmal Atrial Fibrillation: A Randomized Study

Adenosine‐Guided Ablation of Atrial Fibrillation Objectives The prognostic significance of adenosine‐mediated pulmonary vein (PV) dormant conduction and whether such conduction should be eliminated still remain controversial. This randomized study aimed to investigate whether adenosine‐guided ablation of the reconnection gaps improves the long‐term outcomes of pulmonary vein antral isolation (PVAI) for paroxysmal atrial fibrillation (AF). Methods and Results Consecutive patients with paroxysmal AF were randomly assigned to undergo (n = 80, group 1) or not (n = 81, group 2) adenosine testing following PVAI. Adenosine‐mediated PV dormant conduction was unmasked in 26 patients (32.5%) of group 1. Successful elimination of the reconnection gaps was subsequently performed in all patients. During a mean follow‐up period of 11.39 ± 5.10 months, 30 patients of group 1 (37.5%), and 27 patients of group 2 (33.3%) experienced arrhythmia recurrence. The Kaplan–Meier arrhythmia free survival curves failed to demonstrate any significant differences between study groups (log rank 0.217, P = 0.642). Fourteen of 26 (53.8%) patients with adenosine‐mediated dormant conduction and subsequent elimination of reconnection gaps experienced AF recurrence during follow‐up. On the contrary, only 16 of 54 patients without dormant conduction (29.6%) displayed arrhythmia recurrence (P = 0.049). Logistic regression analysis showed that adenosine‐mediated PV reconnection (hazard ratio 0.292, 95% confidence interval 0.122–0.483; P = 0.01) was an independent predictor of AF recurrence. Conclusion In this patients’ cohort, adenosine‐mediated PV reconnection is predictive of future arrhythmic events. Elimination of dormant conduction with additional ablation lesions does not improve the long‐term outcome of the procedure compared to the standard PVAI.