Key result
Intravenous adenosine induced transient conduction in 25% of isolated pulmonary veins, with adenosine-positive veins showing a nonsignificant higher rate of late recovery (71% vs 35%, P=0.095).
Why the study?
Does intravenous adenosine reveal dormant pulmonary vein conduction after successful ostial radiofrequency catheter ablation in patients with atrial fibrillation?
Observational (n=29)
Does intravenous adenosine reveal dormant pulmonary vein conduction after successful ostial radiofrequency catheter ablation in patients with atrial fibrillation?
Intravenous adenosine can reveal dormant pulmonary vein conduction after successful isolation, which may predict future recovery of conduction.
Answers are grounded in this paper and cite their sources.
Adenosine may identify dormant PV conduction after isolation; leaves open whether targeting it reduces late reconnection.
INTRODUCTION: The endogenous nucleoside adenosine is an important intermediate in cellular metabolism, a regulator of function in many organ systems, and a pharmacologic agent with potent electrophysiologic effects. We studied the effects of adenosine on the activation of the pulmonary veins (PVs) after successful ostial isolation in patients with atrial fibrillation (AF). METHODS AND RESULTS: Twenty-nine patients (21 male; mean age 54 +/- 10 years) with refractory highly symptomatic persistent (n = 9) or paroxysmal (n = 20) AF were included in the study. PV isolation was performed using radiofrequency catheter ablation guided by a multipolar basket catheter (Constellation, Boston Scientific). After successful PV isolation, we studied the effects of intravenous adenosine (12-18 mg) on activation of the upper PVs. A total of 83 PVs were successfully isolated. After adenosine, PV activity was recorded in 10 (34%) of 29 left upper PVs studied and in 3 (13%) of 24 right upper PVs, coupled to atrial activity for 20 +/- 7 seconds (adenosine positive). In 8 (62%) of 13 cases, PV potentials were recorded in the distal electrodes of the basket catheter only. Dissociated PV rhythms (N = 8) present after PV isolation disappeared after adenosine for 18 +/- 7 seconds, even if reconduction was missing. In 14 patients (48%), a second EP study was performed for recurrence of AF. Adenosine-positive PVs had a nonsignificant higher rate of recovery of conduction than adenosine-negative veins (71% vs 35%, P = 0.095). CONCLUSION: Adenosine induces transient conduction in 25% of PVs following successful isolation. Further studies are necessary to determine the physiologic or pathophysiologic role of adenosine-induced reconduction in human hearts or other organ systems.
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Arentz et al. (2004) conducted an observational in Atrial fibrillation (n=29). Intravenous adenosine vs. Adenosine-negative veins was evaluated on Recovery of conduction at second EP study (p=0.095). Intravenous adenosine induced transient conduction in 25% of isolated pulmonary veins, with adenosine-positive veins showing a nonsignificant higher rate of late recovery (71% vs 35%, P=0.095).
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