Po-01-042 outcomes in atrial fibrillation using adenosine to check for dormant connections during catheter ablation

Adenosine is used to uncover dormant connections after pulmonary vein isolation (PVI) for atrial fibrillation (AF). There are conflicting reports in the literature on whether this technique reduces AF recurrence. To determine if adenosine provocation (APROV) to check for dormant conduction following PVI reduces AF recurrence. AF ablation procedures performed at a single center from 2013 to 2021 were analyzed. The endpoint was AF recurrence after a 3-month blanking period. AF recurrence was defined as AF lasting for more than 30 seconds. 1:1 propensity score match (PSM) was performed with covariates that have been shown to predict AF recurrence in previous studies (gender, age, BMI, AF classification, obstructive sleep apnea (OSA), hypertension (HTN), and diabetes mellitus (DM). The minimum duration of follow-up was 6 months. Adenosine was used at the procedure physician’s discretion with a minimum dose of 12 mg. Dormant connections were ablated, and persistent PVI with elimination of dormant conduction with adenosine re-challenge was confirmed in all cases. Kaplan-Meier analysis was conducted to assess time to AF recurrence in the entire cohort and the PSM cohort. We analyzed 1544 AF ablations (1111 de novo, 428 repeat ablation) at a single academic medical center. Adenosine was used in 64% of cases. The study population was 65.5% male with a mean age 66 years. Patient co-morbidities included DM (17%), HTN (55%), and OSA (18%). There was no significant difference in time to AF recurrence in the entire cohort with APROV (HR 0.95, CI 0.78-1.16, p=0.6). After PSM, there were 450 patients in each group with AF ablations with 72% paroxysmal AF and 28% persistent AF. There was no difference in time to AF recurrence in the PSM cohort with APROV (HR 0.94, CI 0.75-1.18, p=0.6, Figure 1), with no differences observed between de novo vs repeat ablations. Adenosine provocation is not associated with decreased AF recurrence.