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"Dormant" pulmonary vein conduction revealed by adenosine after ostial radiofrequency catheter ablation.
J Cardiovasc Electrophysiol. 2004 Sep; 15(9):1041-7.JC

Abstract

INTRODUCTION

The endogenous nucleoside adenosine is an important intermediate in cellular metabolism, a regulator of function in many organ systems, and a pharmacologic agent with potent electrophysiologic effects. We studied the effects of adenosine on the activation of the pulmonary veins (PVs) after successful ostial isolation in patients with atrial fibrillation (AF).

METHODS AND RESULTS

Twenty-nine patients (21 male; mean age 54 +/- 10 years) with refractory highly symptomatic persistent (n = 9) or paroxysmal (n = 20) AF were included in the study. PV isolation was performed using radiofrequency catheter ablation guided by a multipolar basket catheter (Constellation, Boston Scientific). After successful PV isolation, we studied the effects of intravenous adenosine (12-18 mg) on activation of the upper PVs. A total of 83 PVs were successfully isolated. After adenosine, PV activity was recorded in 10 (34%) of 29 left upper PVs studied and in 3 (13%) of 24 right upper PVs, coupled to atrial activity for 20 +/- 7 seconds (adenosine positive). In 8 (62%) of 13 cases, PV potentials were recorded in the distal electrodes of the basket catheter only. Dissociated PV rhythms (N = 8) present after PV isolation disappeared after adenosine for 18 +/- 7 seconds, even if reconduction was missing. In 14 patients (48%), a second EP study was performed for recurrence of AF. Adenosine-positive PVs had a nonsignificant higher rate of recovery of conduction than adenosine-negative veins (71% vs 35%, P = 0.095).

CONCLUSION

Adenosine induces transient conduction in 25% of PVs following successful isolation. Further studies are necessary to determine the physiologic or pathophysiologic role of adenosine-induced reconduction in human hearts or other organ systems.

Authors+Show Affiliations

Arentz T
Rhythmologie, Herz-Zentrum, Bad Krozingen, Germany. thomas.arentz@herzzentrum.de
Macle L
No affiliation info available
Kalusche D
No affiliation info available
Hocini M
No affiliation info available
Jais P
No affiliation info available
Shah D
No affiliation info available
Haissaguerre M
No affiliation info available

MeSH

AdenosineAnti-Arrhythmia AgentsAtrial FibrillationCatheter AblationDrug ResistanceFemaleHeart Conduction SystemHumansMaleMiddle AgedProspective StudiesPulmonary Veins

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15363077

Citation

Arentz, Thomas, et al. ""Dormant" Pulmonary Vein Conduction Revealed By Adenosine After Ostial Radiofrequency Catheter Ablation." Journal of Cardiovascular Electrophysiology, vol. 15, no. 9, 2004, pp. 1041-7.
Arentz T, Macle L, Kalusche D, et al. "Dormant" pulmonary vein conduction revealed by adenosine after ostial radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 2004;15(9):1041-7.
Arentz, T., Macle, L., Kalusche, D., Hocini, M., Jais, P., Shah, D., & Haissaguerre, M. (2004). "Dormant" pulmonary vein conduction revealed by adenosine after ostial radiofrequency catheter ablation. Journal of Cardiovascular Electrophysiology, 15(9), 1041-7.
Arentz T, et al. "Dormant" Pulmonary Vein Conduction Revealed By Adenosine After Ostial Radiofrequency Catheter Ablation. J Cardiovasc Electrophysiol. 2004;15(9):1041-7. PubMed PMID: 15363077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Dormant" pulmonary vein conduction revealed by adenosine after ostial radiofrequency catheter ablation. AU - Arentz,Thomas, AU - Macle,Laurent, AU - Kalusche,Dietrich, AU - Hocini,Mélèze, AU - Jais,Pierre, AU - Shah,Dipen, AU - Haissaguerre,Michel, PY - 2004/9/15/pubmed PY - 2005/2/9/medline PY - 2004/9/15/entrez SP - 1041 EP - 7 JF - Journal of cardiovascular electrophysiology JO - J Cardiovasc Electrophysiol VL - 15 IS - 9 N2 - INTRODUCTION: The endogenous nucleoside adenosine is an important intermediate in cellular metabolism, a regulator of function in many organ systems, and a pharmacologic agent with potent electrophysiologic effects. We studied the effects of adenosine on the activation of the pulmonary veins (PVs) after successful ostial isolation in patients with atrial fibrillation (AF). METHODS AND RESULTS: Twenty-nine patients (21 male; mean age 54 +/- 10 years) with refractory highly symptomatic persistent (n = 9) or paroxysmal (n = 20) AF were included in the study. PV isolation was performed using radiofrequency catheter ablation guided by a multipolar basket catheter (Constellation, Boston Scientific). After successful PV isolation, we studied the effects of intravenous adenosine (12-18 mg) on activation of the upper PVs. A total of 83 PVs were successfully isolated. After adenosine, PV activity was recorded in 10 (34%) of 29 left upper PVs studied and in 3 (13%) of 24 right upper PVs, coupled to atrial activity for 20 +/- 7 seconds (adenosine positive). In 8 (62%) of 13 cases, PV potentials were recorded in the distal electrodes of the basket catheter only. Dissociated PV rhythms (N = 8) present after PV isolation disappeared after adenosine for 18 +/- 7 seconds, even if reconduction was missing. In 14 patients (48%), a second EP study was performed for recurrence of AF. Adenosine-positive PVs had a nonsignificant higher rate of recovery of conduction than adenosine-negative veins (71% vs 35%, P = 0.095). CONCLUSION: Adenosine induces transient conduction in 25% of PVs following successful isolation. Further studies are necessary to determine the physiologic or pathophysiologic role of adenosine-induced reconduction in human hearts or other organ systems. SN - 1045-3873 UR - https://www.unboundmedicine.com/medline/citation/15363077/"Dormant"_pulmonary_vein_conduction_revealed_by_adenosine_after_ostial_radiofrequency_catheter_ablation_ DB - PRIME DP - Unbound Medicine ER -