Adenosine testing during cryoballoon ablation and radiofrequency ablation of atrial fibrillation: A propensity score–matched analysis

Background The infusion of adenosine triphosphate after radiofrequency (RF) pulmonary vein (PV) isolation (PVI), which may result in acute transient PV-atrium reconnection, can unmask dormant conduction. Objective The purpose of this study was to compare the incidence and characteristics of dormant conduction after cryoballoon (CB) and RF ablation of atrial fibrillation (AF). Methods Of 414 consecutive patients undergoing initial catheter ablation of paroxysmal AF, 246 (59%) propensity score–matched patients (123 CB-PVI and 123 RF-PVI) were included. Results Dormant conduction was less frequently observed in patients who underwent CB-PVI than in those who underwent RF-PVI (4.5% vs 12.8% of all PVs; P < .0001). The incidence of dormant conduction in each PV was lower in patients who underwent CB-PVI than in those who underwent RF-PVI in the left superior PV ( P < .0001) and right superior PV ( P = .001). The site of dormant conduction was mainly located around the bottom of both inferior PVs after CB-PVI. Multivariable analysis revealed that a longer time to the elimination of the PV potential (odds ratio 1.018; 95% confidence interval 1.001–1.036; P = .04) and the necessity of touch-up ablation (odds ratio 3.242; 95% confidence interval 2.761–7.111; P < .0001) were independently associated with the presence of dormant conduction after CB-PVI. After the elimination of dormant conduction by additional ablation, the AF-free rate was similar in patients with and without dormant conduction after both CB-PVI and RF-PVI ( P = .28 and P = .73, respectively). Conclusion The results of the propensity score–matched analysis showed that dormant PV conduction was less frequent after CB ablation than after RF ablation and was not associated with ablation outcomes.