Adenosine testing for transient conduction recovery after pulmonary vein isolation did not predict clinical recurrence of atrial fibrillation at 1 year (24.0% in TCR+ vs 25.5% in TCR-).
Cohort (n=72)
Does transient conduction recovery after adenosine administration predict clinical recurrence of atrial fibrillation in patients undergoing pulmonary vein isolation?
Adenosine testing for transient conduction recovery immediately after pulmonary vein isolation does not reliably predict long-term clinical recurrence of atrial fibrillation.
Absolute Event Rate: 24% vs 25.5%
BACKGROUND: Approximately 30% of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation (AF) have clinical recurrence of AF, and a great majority of these patients have recovery of vein conduction. Adenosine can be associated with acute recovery of conduction to the pulmonary veins immediately after isolation. However, it is not known whether this is prognostic for permanent recovery of conduction or recurrence of AF. METHODS: Patients with paroxysmal AF underwent PVI, with administration of adenosine after electrical isolation. Those with transient conduction recovery (TCR+) underwent no further ablation and were compared to those without (TCR-) for clinical AF recurrence and conduction recovery at second procedure. RESULTS: Seventy-two consecutive PVI patients were studied (mean age 56.7 ± 9.2, 61 male). Twenty-five (35%) patients had transient recovery of conduction with adenosine. After 1 year, 18 patients (25%) had symptomatic recurrence of AF. In this group of 18 patients, 6 were TCR+ at initial ablation (sensitivity 33%, NPV = 74%). In the remaining group of 54 patients free from AF recurrence, 35 patients (65%) were TCR- at initial ablation (specificity 65%, PPV = 24%). All 18 patients with recurrent AF underwent repeat procedure and had at least 1 pulmonary vein with recurrent conduction. The initial adenosine test correctly predicted 13 out of 36 (36%) veins, with positive predictive value 90% and negative predictive value 15%. CONCLUSIONS: Adenosine testing for TCR does not appear to predict recurrence of clinical AF. TCR- veins remain susceptible to conduction recovery, as determined at the follow-up procedure.
Gula et al. (Thu,) conducted a cohort in Paroxysmal atrial fibrillation (n=72). Adenosine testing with transient conduction recovery (TCR+) vs. No transient conduction recovery (TCR-) was evaluated on Symptomatic recurrence of atrial fibrillation. Adenosine testing for transient conduction recovery after pulmonary vein isolation did not predict clinical recurrence of atrial fibrillation at 1 year (24.0% in TCR+ vs 25.5% in TCR-).