Inducibility of paroxysmal atrial fibrillation by isoproterenol and its relation to the mode of onset of atrial fibrillation

Background: Isoproterenol has been used to assess inducibility during catheter ablation for paroxysmal PAF. However, no studies have determined the sensitivity and specificity of isoproterenol for the induction of AF. It also is not clear whether isoproterenol is equally effective in inducing AF in the clinical subtypes of vagotonic, adrenergic, and random AF.
Objective: To determine the sensitivity and specificity of isoproterenol for the induction of atrial fibrillation (AF).
Methods: Isoproterenol was infused at 5, 10, 15, and 20 μg/min at 2-minute intervals or until AF was induced in 20 control subjects with no history of AF and in 80 patients with PAF.
Results: Among the 20 control subjects, AF was induced by isoproterenol in one patient (5%). Among the 80 patients with PAF, persistent AF was induced in 67 patients (84%, P < 0.001). Isoproterenol induced AF in 15 of 17 patients (88%) with vagotonic AF, 11 of 11 patients (100%) with adrenergic AF, and 41 of 52 patients (79%) with random episodes of AF (P = 0.2). The yield of AF was 11% (9/80) after 5 μg/min, 28% (22/80) after 10 μg/min, 51% (40/78) after 15 μg/min, and 88% (67/76) after 20 μg/min of isoproterenol (P < 0.01). Isoproterenol had to be discontinued in four patients (5%) before reaching the maximum dose due to reversible chest pain or systolic blood pressure <85 mmHg.
Conclusions: Isoproterenol at infusion rates up to 20 μg/min has a high sensitivity (88%) and specificity (95%) for induction of AF in patients with PAF, regardless of whether the clinical subtype is vagotonic, adrenergic, or random.