Adenosine-induced atrial fibrillation during pharmacologic stress testing: Report of eight cases and review of the literature

Kanei, Yumiko; Hanon, Sam; Vantosh, A.; Schweitzer, Paul

doi:10.1016/j.ijcard.2007.05.090

Cited by 23 publications

(16 citation statements)

References 6 publications

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“…Purinergic agonists such as adenosine are well recognized to induce AF episodes in some patients after intravenous administration. 31 One potential mechanism is acceleration and stabilization of atrial reentrant rotors by increased inward-rectifier current. 32 However, another possibility, based on our studies, would be improved conduction through potential PV drivers that fail to induce AF in the absence of adenosine because of poor PV-LA coupling.…”

Section: Novelty and Potential Clinical Relevancementioning

confidence: 99%

Mechanisms by Which Adenosine Restores Conduction in Dormant Canine Pulmonary Veins

et al. 2010

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Background-Adenosine acutely reconnects pulmonary veins (PVs) after radiofrequency application, revealing "dormant conduction" and identifying PVs at risk of reconnection, but the underlying mechanisms are unknown. Methods and Results-Canine PV and left-atrial (LA) action potentials were recorded with standard microelectrodes and ionic currents with whole-cell patch clamp before and after adenosine perfusion. PVs were isolated with radiofrequency current application in coronary-perfused LA-PV preparations. Adenosine abbreviated action potential duration similarly in PV and LA but significantly hyperpolarized resting potential (by 3.9Ϯ0.5%; PϽ0.05) and increased dV/dt max (by 34Ϯ10%) only in PV. Increased dV/dt max was not due to direct effects on I Na , which was reduced similarly by adenosine in LA and PV but correlated with resting-potential hyperpolarization (rϭ0.80). Adenosine induced larger inward rectifier K ϩ current (I KAdo ) in PV (eg, -2.28Ϯ0.04 pA/pF; -100 mV) versus LA (-1.28Ϯ0.16 pA/pF). Radiofrequency ablation isolated PVs by depolarizing resting potential to voltages positive to -60 mV. Adenosine restored conduction in 5 dormant PVs, which had significantly more negative resting potentials (-57Ϯ6 mV) versus nondormant (-46Ϯ5 mV, nϭ6; PϽ0.001) before adenosine. Adenosine hyperpolarized both, but more negative resting-potential values after adenosine in dormant PVs (-66Ϯ6 mV versus -56Ϯ6 mV in nondormant; PϽ0.001) were sufficient to restore excitability. Adenosine effects on resting potential and conduction reversed on washout. Spontaneous recovery of conduction occurring in dormant PVs after 30 to 60 minutes was predicted by the adenosine response. Key Words: arrhythmia ablation Ⅲ adenosine Ⅲ atrium Ⅲ conduction Ⅲ electrophysiology Ⅲ ion channels P ulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). 1,2 Nevertheless, many patients require repeated ablation procedures because of AF recurrence, which in most cases are associated with reconnection of previously isolated PVs. 3,4 It has recently been noted that intravenous purinergic agonists such as adenosine can transiently restore conduction through a previously isolated PV, a phenomenon called "dormant conduction." [5][6][7][8] The demonstration of dormant conduction has predictive value for eventual reconnection, and additional radiofrequency (RF) applications to veins showing dormant conduction at the time of initial PVI may prevent reconnection and AF recurrence. 6 -8 The mechanisms by which adenosine restores conduction to dormant PVs are unknown. The objectives of this study were to (1) explore the effects of adenosine on ionic currents and action potentials (APs) in canine left-atrial (LA) and PV cardiomyocytes, and (2) relate these effects to changes in conduction between the PV and LA after RF ablation in an in vitro model. Conclusions-Adenosine Clinical Perspective on p 972 Materials and MethodsSee the online-only Data Supplement for the complete Materials and Methods section. The following text summarize...

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Section: Novelty and Potential Clinical Relevancementioning

confidence: 99%

Mechanisms by Which Adenosine Restores Conduction in Dormant Canine Pulmonary Veins

et al. 2010

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“…To date, there is already a well-established link between adenosine and its ability to stimulate cardiac arrhythmias [2]. Adenosine infusion used for the diagnosis of coronary disease has confirmed this association, with AF induction following adenosine myocardial perfusion stress testing having been described previously [3]. The mechanism of this association has been attributed to adenosine's ability both to decrease atrial refractory periods as well as to shorten the action potential duration, making the atrial myocardium more susceptible to arrhythmia induction [2,4].…”

Section: Discussionmentioning

confidence: 69%

Adenosine-induced atrial fibrillation during fractional flow reserve measurement

2012

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“…We found predominance of the sympatho-excitatory effect of adenosine [17] that overrides cardiac inhibition comparable to patients without SND resulting in a significant increase in HR. We selected DOO pacing only in patients with sinusbradycardia <45 bpm to prevent competitive atrial stimulation which can induce AF [18], also considering the fact that adenosine may promote AF by shortening the atrial action potential and refractory period [19]. Avoiding competitive atrial stimulation by pacing above intrinsic HR is not useful due to the acceleration of HR under adenosine (up to 40 bpm in tis study).…”

Section: Discussionmentioning

confidence: 99%

Deactivation vs. asynchronous pacing - prospective evaluation of a protocol for rhythm management in patients with magnetic resonance conditional pacemakers undergoing adenosine stress cardiovascular magnetic resonance imaging

Klein-Wiele

Garmer

Barbone

et al. 2017

BMC Cardiovasc Disord

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Background: Cardiovascular Magnetic Resonance (CMR) imaging with adenosine stress is an important diagnostic tool in patients with known or suspected coronary artery disease (CAD). However, the method is not yet established for CAD patients with pacemakers (PM) in clinical practice. A possible reason is that no recommendations exist for PM setting (paused pacing or asynchronous mode) during adenosine stress. We elaborated a protocol for rhythm management in clinical routine for PM patients that considers heart rate changes under adenosine using a test infusion of adenosine in selected patients. Methods: 47 consecutive patients (mean age 72.3 ± 10,0 years) with MR conditional PM and known or suspected CAD who underwent CMR in clinical routine were studied in this prospective observational study. PM indications were sinus node dysfunction (SND, n = 19; 40,4%), atrioventricular (AV) block (n = 26; 55.3%) and bradyarrhythmia in permanent atrial fibrillation (AF, n = 2; 4.3%). In patients with SND, normal AV-conduction and resting HR >45 bpm at the time of CMR and in AF the PM was deactivated for the scan. In intermittent AV-block a test infusion of adenosine was given prior to the scan. All patients with permanent higher degree sinuatrial or AV-block or deterioration of AV-conduction in the adenosine test were paced asynchronously during CMR, in patients with preserved AV-conduction under adenosine the pacemaker was deactivated. CMR protocol included cine imaging, adenosine stress perfusion and late gadolinium enhancement. Results: The adenosine test was able to differentiate between mandatory PM stimulation during CMR and safe deactivation of the device. In patients with permanent sinuatrial or AV-block (n = 11; 23.4%) or deterioration of AV conduction in the adenosine test (n = 5, 10.6%) asynchronous pacing above resting heart rate did not interfere with intrinsic rhythm, no competitive stimulation was seen during the scan. 10 of 15 (66,7%) patients with intermittent AV-block showed preserved AV-conduction under adenosine. As in SND and AF deactivation of the PM showed to be safe during CMR, no bradycardia was observed.

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Adenosine-induced atrial fibrillation during pharmacologic stress testing: Report of eight cases and review of the literature

Cited by 23 publications

References 6 publications

Mechanisms by Which Adenosine Restores Conduction in Dormant Canine Pulmonary Veins

Mechanisms by Which Adenosine Restores Conduction in Dormant Canine Pulmonary Veins

Adenosine-induced atrial fibrillation during fractional flow reserve measurement

Deactivation vs. asynchronous pacing - prospective evaluation of a protocol for rhythm management in patients with magnetic resonance conditional pacemakers undergoing adenosine stress cardiovascular magnetic resonance imaging

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