Is adenosine useful for the identification of atrial fibrillation triggers?

Introduction Both isoproterenol (Iso) and adenosine (Ado) are used to induce atrial fibrillation (AF) in the electrophysiology lab. However, the utility of Ado has not been systematically established. Objective The purpose of this study was to compare Ado to Iso for the induction of paroxysmal AF. Methods Forty patients (16 women; mean age, 60 ± 12 years) with paroxysmal AF, presenting for ablation were prospectively included of whom 36 (90%) received Ado (18‐36 mg) and/or Iso (3‐20 µg/min incremental dose) in a randomized order (26 [72%] received both drugs). Results AF was induced with Iso in 15 of 32 (47%) and with Ado in 12 of 30 (40%) patients (P = 0.9). Iso‐triggered AF started from the left pulmonary veins (PVs) in 11 of 15 (73%), from the right PVs in 3 of 15 (20%), and from the coronary sinus (CS) in 1 of 15 (7%) cases. Ado‐induced AF episodes originated from the left PVs in 6 of 12 (50%), from the right atrium (RA) in 4 of 12 (33%), and from the CS in 2 of 12 (17%) cases. Altogether, Iso‐induced AF was more likely initiated from the PVs (93%) compared with Ado (50%) ( P = 0.02). Ado‐induced non‐PV triggers were not predictive of arrhythmia recurrence after PV isolation. Conclusion Ado much more frequently induces non‐PV triggers, especially from the RA. The clinical significance of these foci, however, is questionable.