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

• Published in: Journal of interventional cardiac electrophysiology Vol. 66; no. 5; pp. 1243 - 1252
• Main Authors: Aldaas, Omar M., Darden, Douglas, Mylavarapu, Praneet S., Han, Frederick T., Hoffmayer, Kurt S., Krummen, David, Ho, Gordon, Raissi, Farshad, Feld, Gregory K., Hsu, Jonathan C.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2023; Springer Nature B.V
• Subjects: Ablation; Anti-Arrhythmia Agents - therapeutic use; Arrhythmia; Atrial Fibrillation; Cardiac arrhythmia; Cardiology; Catheter Ablation - methods; Catheters; Complications; Fibrillation; Humans; Isoproterenol; Medical instruments; Medicine; Medicine & Public Health; Radio frequency; Radiofrequency ablation; Recurrence; Registries; Retrospective Studies; Statistical analysis; Treatment Outcome; Isoproterenol; Catheter ablation; Atrial fibrillation; Outcomes
• ISSN: 1572-8595; 1383-875X; 1572-8595
• DOI: 10.1007/s10840-022-01448-x

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.