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LONDON, UK – Late recurrence of atrial fibrillation (AF) is not reduced in patients whose pulmonary vein isolation (PVI) treatment incorporates the addition of adenosine triphosphate (ATP), according to results of the UNDER-ATP trial.
EMBARGO : 30 August 2015 at 09:00 BST
Results of the trial, presented at ESC Congress 2015 and published simultaneously in The European Heart Journal (to be confirmed), add to the ongoing debate about ATP use in this setting.
The major cause of AF recurrence after PVI has been reported to be electrical reconnection between the left atrium and pulmonary veins, which re-establishes abnormal rhythm, said study investigator Atsushi Kobori, MD, from Kobe City Medical Center General Hospital in Kobe, Japan.
“Radiofrequency ablation around the pulmonary veins can electrically block the connection but sometimes there are hidden gaps,” he explained. “ATP is a chemical that can unmask dormant electrical conduction, therefore we used it after PVI to try to identify these gaps.”
UNDER-ATP (which stands for UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate) included 2,113 patients (59-68 years) undergoing their first PVI for AF at 19 cardiovascular centres in Japan.
Patients were randomly assigned to conventional PVI alone (n=1,001), or with the addition of ATP (n=1,112) after PVI to identify any additional problem areas.
In the ATP group (recommended dose 0.4mg/kg), additional ablation was performed if ATP identified extra trouble spots, whereas in the control group neither ATP or additional ablation was used.
After ablation, ambulatory electrocardiograms (ECG) were recorded twice daily for 2 weeks, with 24-hour ECG monitoring at hospital discharge, 6 months, and 1 year.The primary endpoint of the study was arrhythmias lasting for more than 30 seconds or requiring repeat ablation, hospital admission, cardioversion or antiarrhythmic drugs between 3 months and 1 year post-PVI. At 1 year there was no significant difference in outcomes between the groups, with 68.7% of the ATP patients and 67.1% of control patients free from AF.
“We found no significant impact of ATP on reducing late recurrences of AF,” concluded Dr. Kobori. -- END –
SOURCES OF FUNDING : The study was supported by the Research Institute for Production Development in Kyoto, Japan.DISCLOSURES: Dr. Kobori reports no conflict of interest.
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About the European Society of CardiologyThe European Society of Cardiology (ESC) represents more than 90 000 cardiology professionals across Europe and worldwide. Its mission is to reduce the burden of cardiovascular disease in Europe. About ESC Congress 2015ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2015 takes place 29 August to 2 September at ExCel London in London, UK. Access the scientific programme. More information is available from the ESC Press Office at firstname.lastname@example.org.To access all the scientific resources from the sessions during the congress, visit ESC Congress 365. This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2015. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.
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