Key result
Adenosine testing after pulmonary vein isolation reveals dormant conduction and identifies patients at increased risk for atrial fibrillation recurrence, though the benefit of additional ablation remains controversial.
Why the study?
Does systematic adenosine testing at the end of atrial fibrillation ablation predict or reduce arrhythmia recurrence?
Does systematic adenosine testing at the end of atrial fibrillation ablation predict or reduce arrhythmia recurrence?
The authors favor the use of adenosine testing at the end of AF ablation in patients with paroxysmal AF as an additional step for risk stratification and prediction of arrhythmia recurrence.
Pulmonary vein (PV) reconnection is a major limitation of atrial fibrillation (AF) ablation and is a significant contributor for arrhythmia recurrence, particularly in patients with paroxysmal AF. Recent technological advances, including the use of steerable sheaths and force sensing catheters resulted in reduced incidence of PV reconnection; however its incidence remains unacceptably high. Additional efforts to reduce pulmonary vein reconnection include the use adenosine to detect dormant PV to left atrial (LA) electrical conduction as well as identification of non-PV triggers. While this strategy is associated with an increased detection rate of reconnection that can be further targeted with ablation, its effect on long-term arrhythmia control is controversial. Still, adenosine-induced PV reconnection appears to be an independent predictor of arrhythmia recurrence despite additional ablation. We favor its use in patients with paroxysmal AF as an additional step for risk stratification and prediction of arrhythmia recurrence.
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Contreras‐Valdes et al. (2014) conducted a review in Atrial Fibrillation. Adenosine test was evaluated. Adenosine testing after pulmonary vein isolation reveals dormant conduction and identifies patients at increased risk for atrial fibrillation recurrence, though the benefit of additional ablation remains controversial.
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