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Differential effectiveness of pharmacological strategies to reveal dormant pulmonary vein conduction: a clinical-experimental correlation.
Heart Rhythm. 2011 Sep; 8(9):1426-33.HR

Abstract

BACKGROUND

Atrial fibrillation recurs in ∼30%-40% of patients after pulmonary vein (PV) isolation (PVI) procedures, often because of restored PV-left atrial (LA) conduction. Adenosine or isoproterenol are used clinically to reveal dormant PV conduction and guide additional ablation.

OBJECTIVE

The purpose of this study was to assess the differential efficacy of adenosine and/or isoproterenol in revealing dormant PV conduction.

METHODS

In 25 patients undergoing PVI, dormant conduction was assessed sequentially in response to intravenous adenosine, isoproterenol, and adenosine plus isoproterenol in 100 PVs. To study mechanisms, PVs were isolated by radiofrequency ablation in coronary-perfused canine LA-PV preparations. After PVI, resting membrane potential from PV cells was recorded before and after 1 mM adenosine, 1 μM isoproterenol, 1 μM isoproterenol plus 1 mM adenosine, or no drug (controls).

RESULTS

Clinical PVI was successful in all 100 PVs, with dormant conduction in 31. Sensitivity for dormant conduction was isoproterenol 10%; adenosine 87% (P <.001 vs. isoproterenol); and isoproterenol + adenosine 100% (P = .13 vs. adenosine). Dormant PV conduction in vitro was revealed with adenosine (53%) and adenosine + isoproterenol (60%) but not with isoproterenol alone or in controls (P <.01). Radiofrequency lesions producing PVI depolarized resting membrane potential, causing inexcitability. Postablation, resting membrane potential hyperpolarized after both adenosine and isoproterenol, but adenosine-induced changes were greater (9.1 ± 0.6 mV, vs. 3.8 ± 0.6 mV; P <0.001), with no significant additional effect when isoproterenol was added to adenosine.

CONCLUSION

Adenosine is superior to isoproterenol in revealing dormant PVs clinically and experimentally because of more effective adenosine-induced hyperpolarization. Adding isoproterenol to adenosine had no significant additional value.

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Authors+Show Affiliations

Datino T
Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
Macle L
No affiliation info available
Chartier D
No affiliation info available
Comtois P
No affiliation info available
Khairy P
No affiliation info available
Guerra PG
No affiliation info available
Fernandez-Aviles F
No affiliation info available
Nattel S
No affiliation info available

MeSH

AdenosineAnimalsAnti-Arrhythmia AgentsAtrial FibrillationCardiotonic AgentsCatheter AblationDogsDrug Administration ScheduleFemaleHeart Conduction SystemHumansIsoproterenolMaleMiddle AgedPulmonary Veins

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21699824

Citation

Datino, Tomas, et al. "Differential Effectiveness of Pharmacological Strategies to Reveal Dormant Pulmonary Vein Conduction: a Clinical-experimental Correlation." Heart Rhythm, vol. 8, no. 9, 2011, pp. 1426-33.
Datino T, Macle L, Chartier D, et al. Differential effectiveness of pharmacological strategies to reveal dormant pulmonary vein conduction: a clinical-experimental correlation. Heart Rhythm. 2011;8(9):1426-33.
Datino, T., Macle, L., Chartier, D., Comtois, P., Khairy, P., Guerra, P. G., Fernandez-Aviles, F., & Nattel, S. (2011). Differential effectiveness of pharmacological strategies to reveal dormant pulmonary vein conduction: a clinical-experimental correlation. Heart Rhythm, 8(9), 1426-33. https://doi.org/10.1016/j.hrthm.2011.04.011
Datino T, et al. Differential Effectiveness of Pharmacological Strategies to Reveal Dormant Pulmonary Vein Conduction: a Clinical-experimental Correlation. Heart Rhythm. 2011;8(9):1426-33. PubMed PMID: 21699824.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential effectiveness of pharmacological strategies to reveal dormant pulmonary vein conduction: a clinical-experimental correlation. AU - Datino,Tomas, AU - Macle,Laurent, AU - Chartier,Denis, AU - Comtois,Philippe, AU - Khairy,Paul, AU - Guerra,Peter G, AU - Fernandez-Aviles,Francisco, AU - Nattel,Stanley, Y1 - 2011/04/12/ PY - 2011/03/04/received PY - 2011/04/01/accepted PY - 2011/6/25/entrez PY - 2011/6/28/pubmed PY - 2012/1/10/medline SP - 1426 EP - 33 JF - Heart rhythm JO - Heart Rhythm VL - 8 IS - 9 N2 - BACKGROUND: Atrial fibrillation recurs in ∼30%-40% of patients after pulmonary vein (PV) isolation (PVI) procedures, often because of restored PV-left atrial (LA) conduction. Adenosine or isoproterenol are used clinically to reveal dormant PV conduction and guide additional ablation. OBJECTIVE: The purpose of this study was to assess the differential efficacy of adenosine and/or isoproterenol in revealing dormant PV conduction. METHODS: In 25 patients undergoing PVI, dormant conduction was assessed sequentially in response to intravenous adenosine, isoproterenol, and adenosine plus isoproterenol in 100 PVs. To study mechanisms, PVs were isolated by radiofrequency ablation in coronary-perfused canine LA-PV preparations. After PVI, resting membrane potential from PV cells was recorded before and after 1 mM adenosine, 1 μM isoproterenol, 1 μM isoproterenol plus 1 mM adenosine, or no drug (controls). RESULTS: Clinical PVI was successful in all 100 PVs, with dormant conduction in 31. Sensitivity for dormant conduction was isoproterenol 10%; adenosine 87% (P <.001 vs. isoproterenol); and isoproterenol + adenosine 100% (P = .13 vs. adenosine). Dormant PV conduction in vitro was revealed with adenosine (53%) and adenosine + isoproterenol (60%) but not with isoproterenol alone or in controls (P <.01). Radiofrequency lesions producing PVI depolarized resting membrane potential, causing inexcitability. Postablation, resting membrane potential hyperpolarized after both adenosine and isoproterenol, but adenosine-induced changes were greater (9.1 ± 0.6 mV, vs. 3.8 ± 0.6 mV; P <0.001), with no significant additional effect when isoproterenol was added to adenosine. CONCLUSION: Adenosine is superior to isoproterenol in revealing dormant PVs clinically and experimentally because of more effective adenosine-induced hyperpolarization. Adding isoproterenol to adenosine had no significant additional value. SN - 1556-3871 UR - https://www.unboundmedicine.com/medline/citation/21699824/Differential_effectiveness_of_pharmacological_strategies_to_reveal_dormant_pulmonary_vein_conduction:_a_clinical_experimental_correlation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1547-5271(11)00442-5 DB - PRIME DP - Unbound Medicine ER -