Key result
Adenosine administration transiently or permanently restored left atrium-to-pulmonary vein conduction in 35% (22/62) of apparently successfully isolated pulmonary veins.
Why the study?
Does a 12 mg intravenous bolus of adenosine restore atrio-venous conduction after apparently successful ostial isolation of the pulmonary veins in patients with atrial fibrillation?
Observational (n=29)
Does a 12 mg intravenous bolus of adenosine restore atrio-venous conduction after apparently successful ostial isolation of the pulmonary veins in patients with atrial fibrillation?
Adenosine administration can unmask dormant LA-PV conduction after apparently successful PV isolation, allowing for targeted additional ablation to ensure permanent isolation.
Adenosine may unmask dormant LA-PV conduction after apparent isolation; leaves open whether targeted re-ablation improves long-term outcomes.
AIMS: Pulmonary vein (PV) isolation is a curative treatment for patients with atrial fibrillation. The aim of this study was to evaluate prospectively the effects of adenosine administration on the PV activity and atrio-venous conduction after PV isolation. METHODS AND RESULTS: Twenty-nine patients (21 m; age: 55+/-8 years) were submitted to ostial PV isolation guided by basket catheter recordings. After successful isolation, the effects of a 12 mg intravenous bolus of adenosine were tested in 62 PVs. In 22/62 PVs (35%), left atrium (LA)-to-PV conduction was transiently (16.6+/-7.1 s, range: 3.8-27.9 s) or permanently (3 PVs) restored in response to adenosine administration. The prevalence of this phenomenon was 39% in left superior PVs, 43% in right superior PVs, and 22% in left inferior PVs (p=0.365). It occurred more frequently in the presence of dissociated PV activity (11/15 PVs, 73% vs. 11/47 PVs, 23%; p=0.002), whereas it was not influenced by the median duration of the radiofrequency current (RFC) delivery for each PV [19 (IQR: 12-26) min vs. 16 (IQR: 11-24) min: p=0.636]. A lengthening or shortening of the LA-PV conduction time was observed at LA-PV conduction appearance and disappearance in 36% and 55% of the cases, respectively. Further RFC applications (median: 5.5 min, IQR: 4-11 min) at the residual conduction breakthrough(s) indicated by the basket catheter recordings definitively eliminated adenosine-induced recovery of LA-PV conduction in all cases. Finally, when present, intrinsic PV discharge was invariably depressed by adenosine administration. CONCLUSIONS: Adenosine may transiently or permanently re-establish LA-PV conduction after apparently successful PV isolation. This phenomenon is abolished by additional RFC delivery. However, its possible influence on the clinical results of PV ablation must be evaluated by properly designed, randomized studies.
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Tritto et al. (2004) conducted an observational in Atrial fibrillation (n=29). Adenosine was evaluated on Restoration of left atrium-to-pulmonary vein conduction. Adenosine administration transiently or permanently restored left atrium-to-pulmonary vein conduction in 35% (22/62) of apparently successfully isolated pulmonary veins.
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