Repeated Provocation of Time- and ATP-Induced Early Pulmonary Vein Reconnections After Pulmonary Vein Isolation

Abstract

Background-Recurrence of atrial fibrillation (AF) after successful pulmonary vein isolation (PVI) occurs mainly due to the reconnection of the once isolated PV. Although provocation and elimination of the early pulmonary vein reconnection (EPVR) soon after PVI has been widely performed to improve the outcome, AF recurrence due to subsequent PV reconnections still occurs. In this study, we repeatedly provoked and eliminated the EPVR to determine the appropriate procedural end point. Methods and Results-Seventy-five patients with paroxysmal AF underwent PVI. EPVR was provoked by both time and ATP induction every 30 minutes until 90 minutes after the individual isolation of all PVs. The number of reconnected atrio-PV gaps were evaluated and reablated at each provocation step. Although both time-and ATP-dependent EPVR was induced most frequently at 30 minutes after PVI (75 and 76 gaps, respectively), the prevalence of induced EPVR at 60 minutes was still high (64 and 36 gaps induced by time and ATP, respectively). Only a small number of EPVR appeared at 90 minutes after the elimination of all EPVR by 60 minutes (8 gaps, PϽ0.01). During the mean follow-up period of 370 days, 92% of cases were free from AF without antiarrhythmic drugs. Conclusions-Provocation and elimination of time-and ATP-induced EPVR not only at 30 minutes but also at 60 minutes is recommended after PVI to improve its efficacy. (Circ Arrhythm Electrophysiol. 2011;4:601-608.)

Optimal observation time after completion of circumferential pulmonary vein isolation for atrial fibrillation to prevent chronic pulmonary vein reconnections

“…These previous studies were of PVs with a relatively short observation time of 20-60 min after the PVI. In other studies of PVs with a relatively long observation time of 60-90 min after the PVI, APVR tended to be more frequently observed than in the present study [30,31]. Cheema et al reported that 33% of the PVs revealed a first reconnection by 30 min and in total, 50% by 60 min [30].…”

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

“…460,469,470 A prospective clinical and experimental evaluation of various pharmacological strategies found that adenosine was superior to an isoproterenol infusion, with no significant additional value of combining the two. 471 Therefore, although isoproterenol infusion can be used to identify non-PV triggers in paroxysmal and persistent AF, there is only a limited role of isoproterenol infusion alone to reveal dormant PV conduction after PVI.…”

Acute Safety and Efficacy of a Novel Multipolar Irrigated Radiofrequency Ablation Catheter for Pulmonary Vein Isolation

“…Even though numbers are small, this may point towards a less effective initial PV isolation and potentially a longer waiting period after PVI or the use of adenosine would have shown higher reconnection rates. 9 The effects on long-term persistent PVI and efficacy of the procedure can only be speculated. Further studies on rhythm follow-up are urgently needed to identify the potential trade-off for potentially lower incidences of collateral damage.…”