Value of adenosine test to reveal dormant conduction or adenosine‐induced atrial fibrillation after pulmonary vein isolation

Abstract

BackgroundRecent studies investigating the implications of additional ablation guided by dormant pulmonary vein (PV) conduction testing using adenosine showed conflicting results, and the data about atrial fibrillation (AF) recurrence after trigger site elimination in adenosine-induced AF are still lacking.MethodsOf 846 patients with paroxysmal AF (PAF) who underwent PV isolation (PVI), adenosine test after PVI was performed in 148 patients.ResultsPVI was successfully achieved in 846 patients. We excluded 58 patients due to loss to the follow-up. A higher rate of AF recurrence was found in the group without adenosine test (136/644, 21%) compared to the group with adenosine test (20/144, 13%, log-rank P=0.047). In multivariate analysis model for AF freedom during the follow-up period, the only significant clinical predictor of AF freedom was adenosine test (hazard ratio [HR] 1.97; 95% confidence interval [CI]: 1.2–3.23; P=0.007).Among 148 patients with adenosine test, 114 (77%) patients showed neither dormant conductions nor AF-induced, 22 (15%) showed positive dormant conductions only, and 12 (8%) revealed adenosine-induced AF (6 of them also showed dormant conduction). After additional ablation in positive dormant conduction group and adenosine-induced AF group, AF recurrence was noted in 4/21 (19%) patients in positive dormant conduction group and 2/11 (18%) patients in adenosine-induced AF group, which was not different from that of patients in negative dormant conduction/ no AF-induced group (14/112, 12%, log-rank P=0.67).ConclusionsAdenosine test after PVI to confirm the absence of dormant conduction and triggers initiating AF is beneficial to improve the outcomes after catheter ablation of PAF.

WPW Syndrome: Review of the Evidence

“…By doing this, APs are eliminated, or their number is reduced, which in addition to treating WPW and removing the delta wave in the ECG by preventing AP from preventing induced AF. In those who do not have surgery, FLACAINID is used in combination with BISOPROLOL, which is an effective way to control PSVT or AF, which can eventually eliminate the wave on the ECG [43]. However, AP Ablation can generally be used to treat people with overt or covert WPW, with or without AF [10].…”

“…In patients with WPW who have pre-exited AF, the use of AV node blockers such as adenosine, digoxin, non-dihydropyridine, calcium channel Blockers, intravenous amiodarone) are contraindicated [43]. Because following their consumption, ventricular velocity becomes excessive (200-240 beats per minute) which can lead to catastrophic consequences such as VF and sudden death, and their prescription in these conditions is considered medical malpractice [56].…”

Adenosine plasma level in patients with paroxysmal or persistent atrial fibrillation and normal heart during ablation procedure and/or cardioversion

“…The nucleoside impacts the cardiovascular system via four membrane receptors namely A 1 R, A 2A R, A 2B R, and A 3 R receptors, pending on their pharmacological properties [2]. Exogenous adenosine administration can provoke spontaneous AF in up to 10% of susceptible patients [3,4], and during AF ablation procedures, exogenous administration of adenosine induces transient reconnection of isolated pulmonary veins (PV) [5][6][7]. Moreover, exogenous adenosine can induce PV ectopic beats in electrically silent PV after isolation.…”