Adenosine triphosphate-guided pulmonary vein isolation for atrial fibrillation: the UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate (UNDER-ATP) trial

Abstract

In the catheter ablation for AF, we found no significant reduction in the 1-year incidence of recurrent atrial tachyarrhythmias by ATP-guided PVI compared with conventional PVI.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…U pacjentów z udokumentowanym trzepotaniem zależnym od cieśni trójdzielno-żylnej, u których wykonuje się ablację AF, zaleca się ablację cieśni. Próby z zastosowaniem adenozyny w celu identyfikacji pacjentów wymagających dodatkowej ablacji pozostają kontrowersyjne po dokonaniu oceny tej metody w kilku doniesieniach [739,[742][743][744]. Ablacja tak zwanych rotorów, oparta na mapowaniu z powierzchni ciała lub mapowaniu wsierdziowym, jest przedmiotem oceny i obecnie nie można zalecać jej wykonywania w rutynowej praktyce klinicznej.…”

The year in cardiology 2015: arrhythmias and device therapy

“…3 However, a much bigger randomized trial published in European Heart Journal now questioned the usefulness of adenosine testing: in the Japanese UNDER anti-tachycardia pacing (ATP) Trial, 2113 patients were randomized to either adenosine challenge or control and no difference in AF recurrence rate was shown at 1 year. 4 The reasons for the contradictory results reported from these two multi-centre, randomized trials are unclear at present and deserve further investigation. Treatment with anti-arrhythmic drugs after catheter ablation was shown to reduce the AF recurrence 90 days after catheter ablation in the EAST AF trial, however, at 1 year there was no difference in arrhythmia recurrence between treatment and control group.…”

The burden of proof: The current state of atrial fibrillation prevention and treatment trials

“…In the UNDER-ATP (UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate) trial, in which the prevalence of dormant conduction after ablation with combined anatomic and electrophysiologic guidance was 20%–30% among patients with paroxysmal, persistent, or longstanding persistent AF (vs 50% in the ADVICE trial), no significant reduction in the incidence of recurrent atrial arrhythmias was observed compared with conventional PVI (Table 3). 67 …”