Adenosine restores atrio-venous conduction after apparently successful ostial isolation of the pulmonary veins

Tritto, Massimo; Ponti, Roberto De; Salerno‐Uriarte, Jorge A.; Spadacini, Giammario; Marazzi, Raffaella; Moretti, Paolo; Lanzotti, M.

doi:10.1016/j.ehj.2004.08.023

Cited by 92 publications

(115 citation statements)

References 15 publications

(23 reference statements)

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“…463,464,465,466,467 The ability of adenosine to unmask dormant PV reconnection is impacted by the adenosine dose as well as by the waiting time since initial documentation of PVI. 466,467 The results of one recent study suggest that the demonstration of a physiological effect of adenosine (e.g., sinus tachycardia, hypotension) is inadequate, and that sufficient adenosine needs to be administered to demonstrate transient AV block.…”

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,754

1,468

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Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,754

1,468

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“…[6][7][8][9][10] Datino et al 19 elegantly showed that conduction recovery was related to adenosine-induced hyperpolarization of the PVs via an increase in the inward rectifier potassium current I Kado in a canine preparation. Hyperpolarization facilitated the closure of the inactivated sodium channels, making them available for activation, and resulted in resumed conduction in tissue where reversible thermal heating had occurred.…”

Section: Adenosine Test At the Index Ablation Proceduresmentioning

confidence: 99%

“…Any gap responsible for dormant conduction was eliminated by additional RF application. [7][8][9] At the repeat procedure, the dormant conduction was evaluated in the same way.…”

Section: Catheter Ablation At Index Proceduresmentioning

confidence: 99%

“…4,5 Because adenosine can reveal dormant PV conduction immediately after isolation, adenosine test has been recognized as a useful technique to predict acute PV reconnection at the index AF ablation procedure. [6][7][8][9][10] However, the utility of adenosine test at repeat ablation procedure undertaken for recurrent atrial tachyarrhythmias has not been reported. We present a series of cases of recurrent atrial tachyarrhythmias in which the successful elimination of adenosine-provoked transient thoracic vein reconduction led to freedom from recurrent arrhythmia.…”

mentioning

confidence: 99%

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Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Miyazaki

Kobori

Komatsu

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Correspondence to Shinsuke Miyazaki, MD, Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan. E-mail mshinsuke@k3.dion.ne.jp Background-Pulmonary vein reconnection after electrical isolation is commonly observed in the context of atrial fibrillation ablation and is associated with recurrent atrial tachyarrhythmias. Adenosine test was been performed to identify acute dormant conduction immediately after pulmonary vein isolation at index procedure. However, the utility of adenosine test at repeat procedure has not been reported. Methods and Results-We report 5 paroxysmal atrial fibrillation cases without any structural heart disease in which dormant thoracic vein conduction was associated with recurrent atrial tachyarrhythmias. All patients had undergone circumferential ipsilateral pulmonary vein isolation at the index procedure. Superior vena cava isolation was performed if superior vena cava-triggered atrial fibrillation was identified. At the index procedure, adenosine test did not provoke venous reconduction. At the repeat procedure, adenosine provoked clinical arrhythmia in 4 out of 5 cases after transient reconnection between culprit thoracic vein and atrium despite absence of reconnection at the start of the procedure. After the elimination of the dormant conduction gaps, all patients were free from recurrent arrhythmia. Conclusions-Adenosine provokes dormant thoracic vein conduction associated with the late recurrence of atrial tachyarrhythmias after previous thoracic vein isolation. Thus, adenosine provocation test can specifically help identify and target the cause of recurrent atrial arrhythmia. (Circ Arrhythm Electrophysiol. 2012;5:1117-1123.)

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“…These studies have suggested that ablation guided by adenosine triphosphate (ATP)/adenosine administration can reduce AF recurrences at 1 year by 32-50 % (relative risk reduction). [53][54][55][56][57] Despite a lower incidence of DC (13-40 %), a similar effect has been suggested after cryoablation of the PV. 58,59 The recently-published randomised Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination (ADVICE) study was the first to prospectively evaluate the impact of adenosine testing on clinical outcomes after AF ablation.…”

Section: Clinical Valuementioning

confidence: 56%

Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, occurring in approximately 2 % of the general population.1-3 A progressive increase in both the prevalence and incidence of AF has been demonstrated in recent years, defining AF as a major economic and public health issue. 1 The identification of sites of AF initiation and/or maintenance within the pulmonary veins (PVs) has led to the development of percutaneous procedures to electrically isolate the PVs from the left atrium (LA). 4 Large observational studies and multiple randomised-controlled trials have demonstrated that catheter ablation is universally superior to anti-arrhythmic drugs (AADs) for the maintenance of sinus rhythm (66-89 % versus 9-58 %, respectively) and results in a greater improvement in arrhythmia-related symptoms, exercise capacity and quality of life.1,2,5-8 As a result, catheter ablation has become the 'standard of care' for the maintenance of sinus rhythm in symptomatic patients in whom drugs are ineffective or poorly tolerated.While the results of ablation are unequivocally superior to medical therapy, they are unfortunately not flawless: approximately 30 % of paroxysmal AF patients will experience arrhythmia recurrence after a single ablation procedure.8 As most recurrences are in association with PV reconnection or as a result of non-PV triggers, several pharmacological challenges have been proposed to improve outcomes. [9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures. Pathophysiology of Atrial Fibrillation and Atrial Fibrillation Catheter AblationDespite decades of progress, there is no comprehensive pathophysiological explanation of AF. Early hypotheses postulated that AF resulted from the co-existence of multiple independent wavelets propagating randomly throughout the left and right atria (the 'multiple wavelet hypothesis'). 13,14 This hypothesis suggested that as long as the atria had a sufficient electrical mass, and an adequately short refractory period, AF could be initiated and indefinitely perpetuated. 15 Based on this theory, the early surgical interventions for AF were designed to reduce the excitable mass of atrial tissue by compartmentalising the atria into smaller regions incapable of sustaining a critical number of circulating wavelets. 16 Unfortunately this strategy has proved to be of limited efficacy and has been associated with a substantial risk of major complications. 17In the late 1990s, Haïssaguerre and colleagues demonstrated that AF is a triggered arrhythmia initiated by rapid repetitive discharges, predominantly from the proximal aspect of the PVs. 4 This discovery led to the development of percutaneous procedures to directly eliminate spontaneous focal ectopic activity within the PVs. However, early AF recurrences from the targeted and other nontargeted PVs led to modification of the ablation strategy to electrically isolate all of the PV...

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Adenosine restores atrio-venous conduction after apparently successful ostial isolation of the pulmonary veins

Cited by 92 publications

References 15 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Pharmacological Tests in Atrial Fibrillation Ablation

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