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Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial

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Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. / Macle, Laurent; Khairy, Paul; Weerasooriya, Rukshen; Novak, Paul; Verma, Atul; Willems, Stephan; Arentz, Thomas; Deisenhofer, Isabel; Veenhuyzen, George; Scavée, Christophe; Jaïs, Pierre; Puererfellner, Helmut; Levesque, Sylvie; Andrade, Jason G; Rivard, Lena; Guerra, Peter G; Dubuc, Marc; Thibault, Bernard; Talajic, Mario; Roy, Denis; Nattel, Stanley; ADVICE trial investigators.

In: LANCET, Vol. 386, No. 9994, 15.08.2015, p. 672-679.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Macle, L, Khairy, P, Weerasooriya, R, Novak, P, Verma, A, Willems, S, Arentz, T, Deisenhofer, I, Veenhuyzen, G, Scavée, C, Jaïs, P, Puererfellner, H, Levesque, S, Andrade, JG, Rivard, L, Guerra, PG, Dubuc, M, Thibault, B, Talajic, M, Roy, D, Nattel, S & ADVICE trial investigators 2015, 'Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial', LANCET, vol. 386, no. 9994, pp. 672-679. https://doi.org/10.1016/S0140-6736(15)60026-5

APA

Macle, L., Khairy, P., Weerasooriya, R., Novak, P., Verma, A., Willems, S., Arentz, T., Deisenhofer, I., Veenhuyzen, G., Scavée, C., Jaïs, P., Puererfellner, H., Levesque, S., Andrade, J. G., Rivard, L., Guerra, P. G., Dubuc, M., Thibault, B., Talajic, M., ... ADVICE trial investigators (2015). Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. LANCET, 386(9994), 672-679. https://doi.org/10.1016/S0140-6736(15)60026-5

Vancouver

Macle L, Khairy P, Weerasooriya R, Novak P, Verma A, Willems S et al. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. LANCET. 2015 Aug 15;386(9994):672-679. https://doi.org/10.1016/S0140-6736(15)60026-5

Bibtex

@article{221577ceecfb4b8eb822d2bb6249aad4,
title = "Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial",
abstract = "BACKGROUND: Catheter ablation is increasingly used to manage atrial fibrillation, but arrhythmia recurrences are common. Adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve arrhythmia-free survival. We assessed whether adenosine-guided pulmonary vein isolation could prevent arrhythmia recurrence in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation.METHODS: We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled patients aged older than 18 years who had had at least three symptomatic atrial fibrillation episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned (1:1) to additional adenosine-guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction was revealed, randomly selected patients were included in a registry. Patients were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. Patients were followed up for 1 year. The primary outcome was time to symptomatic atrial tachyarrhythmia after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980.FINDINGS: Adenosine unmasked dormant pulmonary vein conduction in 284 (53%) of 534 patients. 102 (69·4%) of 147 patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 58 (42·3%) of 137 patients with no further ablation, corresponding to an absolute risk reduction of 27·1% (95% CI 15·9-38·2; p<0·0001) and a hazard ratio of 0·44 (95% CI 0·31-0·64; p<0·0001). Of 115 patients without dormant pulmonary vein conduction, 64 (55·7%) remained free from symptomatic atrial tachyarrhythmia (p=0·0191 vs dormant conduction with no further ablation). Occurrences of serious adverse events were similar in each group. One death (massive stroke) was deemed probably related to ablation in a patient included in the registry.INTERPRETATION: Adenosine testing to identify and target dormant pulmonary vein conduction during catheter ablation of atrial fibrillation is a safe and highly effective strategy to improve arrhythmia-free survival in patients with paroxysmal atrial fibrillation. This approach should be considered for incorporation into routine clinical practice.FUNDING: Canadian Institutes of Health Research, St Jude Medical, Biosense-Webster, and M Lachapelle (Montreal Heart Institute Foundation).",
keywords = "Adenosine, Anti-Arrhythmia Agents, Atrial Fibrillation/surgery, Catheter Ablation/methods, Female, Humans, Male, Middle Aged, Operative Time, Proportional Hazards Models, Pulmonary Veins/drug effects, Secondary Prevention, Treatment Outcome",
author = "Laurent Macle and Paul Khairy and Rukshen Weerasooriya and Paul Novak and Atul Verma and Stephan Willems and Thomas Arentz and Isabel Deisenhofer and George Veenhuyzen and Christophe Scav{\'e}e and Pierre Ja{\"i}s and Helmut Puererfellner and Sylvie Levesque and Andrade, {Jason G} and Lena Rivard and Guerra, {Peter G} and Marc Dubuc and Bernard Thibault and Mario Talajic and Denis Roy and Stanley Nattel and {ADVICE trial investigators}",
note = "Copyright {\textcopyright} 2015 Elsevier Ltd. All rights reserved.",
year = "2015",
month = aug,
day = "15",
doi = "10.1016/S0140-6736(15)60026-5",
language = "English",
volume = "386",
pages = "672--679",
journal = "LANCET",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "9994",

}

RIS

TY - JOUR

T1 - Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial

AU - Macle, Laurent

AU - Khairy, Paul

AU - Weerasooriya, Rukshen

AU - Novak, Paul

AU - Verma, Atul

AU - Willems, Stephan

AU - Arentz, Thomas

AU - Deisenhofer, Isabel

AU - Veenhuyzen, George

AU - Scavée, Christophe

AU - Jaïs, Pierre

AU - Puererfellner, Helmut

AU - Levesque, Sylvie

AU - Andrade, Jason G

AU - Rivard, Lena

AU - Guerra, Peter G

AU - Dubuc, Marc

AU - Thibault, Bernard

AU - Talajic, Mario

AU - Roy, Denis

AU - Nattel, Stanley

AU - ADVICE trial investigators

N1 - Copyright © 2015 Elsevier Ltd. All rights reserved.

PY - 2015/8/15

Y1 - 2015/8/15

N2 - BACKGROUND: Catheter ablation is increasingly used to manage atrial fibrillation, but arrhythmia recurrences are common. Adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve arrhythmia-free survival. We assessed whether adenosine-guided pulmonary vein isolation could prevent arrhythmia recurrence in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation.METHODS: We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled patients aged older than 18 years who had had at least three symptomatic atrial fibrillation episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned (1:1) to additional adenosine-guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction was revealed, randomly selected patients were included in a registry. Patients were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. Patients were followed up for 1 year. The primary outcome was time to symptomatic atrial tachyarrhythmia after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980.FINDINGS: Adenosine unmasked dormant pulmonary vein conduction in 284 (53%) of 534 patients. 102 (69·4%) of 147 patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 58 (42·3%) of 137 patients with no further ablation, corresponding to an absolute risk reduction of 27·1% (95% CI 15·9-38·2; p<0·0001) and a hazard ratio of 0·44 (95% CI 0·31-0·64; p<0·0001). Of 115 patients without dormant pulmonary vein conduction, 64 (55·7%) remained free from symptomatic atrial tachyarrhythmia (p=0·0191 vs dormant conduction with no further ablation). Occurrences of serious adverse events were similar in each group. One death (massive stroke) was deemed probably related to ablation in a patient included in the registry.INTERPRETATION: Adenosine testing to identify and target dormant pulmonary vein conduction during catheter ablation of atrial fibrillation is a safe and highly effective strategy to improve arrhythmia-free survival in patients with paroxysmal atrial fibrillation. This approach should be considered for incorporation into routine clinical practice.FUNDING: Canadian Institutes of Health Research, St Jude Medical, Biosense-Webster, and M Lachapelle (Montreal Heart Institute Foundation).

AB - BACKGROUND: Catheter ablation is increasingly used to manage atrial fibrillation, but arrhythmia recurrences are common. Adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve arrhythmia-free survival. We assessed whether adenosine-guided pulmonary vein isolation could prevent arrhythmia recurrence in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation.METHODS: We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled patients aged older than 18 years who had had at least three symptomatic atrial fibrillation episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned (1:1) to additional adenosine-guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction was revealed, randomly selected patients were included in a registry. Patients were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. Patients were followed up for 1 year. The primary outcome was time to symptomatic atrial tachyarrhythmia after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980.FINDINGS: Adenosine unmasked dormant pulmonary vein conduction in 284 (53%) of 534 patients. 102 (69·4%) of 147 patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 58 (42·3%) of 137 patients with no further ablation, corresponding to an absolute risk reduction of 27·1% (95% CI 15·9-38·2; p<0·0001) and a hazard ratio of 0·44 (95% CI 0·31-0·64; p<0·0001). Of 115 patients without dormant pulmonary vein conduction, 64 (55·7%) remained free from symptomatic atrial tachyarrhythmia (p=0·0191 vs dormant conduction with no further ablation). Occurrences of serious adverse events were similar in each group. One death (massive stroke) was deemed probably related to ablation in a patient included in the registry.INTERPRETATION: Adenosine testing to identify and target dormant pulmonary vein conduction during catheter ablation of atrial fibrillation is a safe and highly effective strategy to improve arrhythmia-free survival in patients with paroxysmal atrial fibrillation. This approach should be considered for incorporation into routine clinical practice.FUNDING: Canadian Institutes of Health Research, St Jude Medical, Biosense-Webster, and M Lachapelle (Montreal Heart Institute Foundation).

KW - Adenosine

KW - Anti-Arrhythmia Agents

KW - Atrial Fibrillation/surgery

KW - Catheter Ablation/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Operative Time

KW - Proportional Hazards Models

KW - Pulmonary Veins/drug effects

KW - Secondary Prevention

KW - Treatment Outcome

U2 - 10.1016/S0140-6736(15)60026-5

DO - 10.1016/S0140-6736(15)60026-5

M3 - SCORING: Journal article

C2 - 26211828

VL - 386

SP - 672

EP - 679

JO - LANCET

JF - LANCET

SN - 0140-6736

IS - 9994

ER -