Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Abstract

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.)

Reappraisal of the clinical implications of adenosine triphosphate in terms of the prediction of reconnection sites in cases with electrical isolation of the pulmonary veins

“…Although Datino et al elegantly demonstrated that adenosine acutely restores the PV-LA conduction by hyperpolarizing the PV cardiomyocytes and activating the outward K+ currents leading to a cellular hyperpolarization, especially in atrial cells, as well as an increase in the INa+ as a result of removing the voltage-dependent inactivation, not all the DC sites revealed by this electrical action of adenosine could always be precisely predicted in the present study [15]. Miyazaki et al reported five patients in whom DC leading to late recurrent atrial arrhythmias after AF ablation could be revealed by an adenosine test during the repeat ablation procedure, and which also lead to the complete freedom from recurrent atrial arrhythmias [16]. However, they speculated that the evaluation of the genuine contribution of the adenosine test was quite difficult because of the possibility of time-dependent spontaneous PV reconnections and the impact of RF-induced reversible tissue edema or inflammation.…”

Adenosine-Provoked Atrial Fibrillation Originating From Non–Pulmonary Vein Foci

“…ATP tests were undertaken with the same protocol as during the index procedure even in cases without any PV reconnections at baseline(14). When an arrhythmogenic SVC was identified during the procedure(Figure 1), an electrical isolation was performed.…”

Clinical Impact of Adenosine Triphosphate Injection on Arrhythmogenic Superior Vena Cava in the Context of Atrial Fibrillation Ablation

“…The mechanism has been related to incomplete lesions, which leaves damaged but viable muscle sleeves that can recover, 11 and adenosine/ATP test has been reported to be a useful to identify the dormancy after PV isolation at acute [12][13][14] and chronic phases. 15 However, the clinical impact of adenosine/ ATP injection on SVC reconnection has not been evaluated. The objective of this study is to investigate the clinical impact of ATP injection on arrhythmogenic SVC in the context of AF ablation.…”