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Time course of adenosine-induced pulmonary vein reconnection after isolation: implications for mechanism of dormant conduction.
Pacing Clin Electrophysiol. 2012 May; 35(5):556-63.PC

Abstract

BACKGROUND

Adenosine (ADO) has been proposed to reconnect isolated pulmonary veins (PVs) postablation through hyperpolarization of damaged myocytes in an animal model. However, PV reconnection can occur via ADO-mediated sympathetic activation. We sought to determine the mechanism of ADO-induced PV reconnection in the clinical setting by characterizing its time course and location in patients undergoing PV isolation.

METHODS

Seventy-four patients (61 male; age 61 ± 10 years) undergoing PV isolation for atrial fibrillation (54 [73%] paroxysmal and 19 [27%] persistent) were studied. After each PV was isolated, a 12-mg intravenous bolus of ADO was administered and onset, offset, and location of ADO-induced PV reconnection and onset and offset of bradycardia were analyzed.

RESULTS

In 22 (30%) patients, ADO-induced PV reconnection occurred in 34 of 270 (13%) PVs. In 24 (71%) PVs, the duration of ADO-induced reconnection exceeded that of bradycardia. The onset of ADO-induced reconnection occurred before the onset of bradycardia in 10 (30%) PVs and during bradycardia in 23 (70%) PVs. No PVs exhibited onset of reconnection after resolution of bradycardia. Common sites of PV reconnection included the carinal region (41% of right PVs and 29% of left PVs) and left PV-atrial appendageal ridge region (35% of left PVs).

CONCLUSIONS

ADO-induced PV reconnection occurs during the bradycardic phase of the ADO bolus response and not during the late tachycardic phase. ADO-induced PV dormant conduction is closely associated with the negative dromotropic effects of ADO and suggests that hyperpolarization of the resting membrane is the unifying mechanism.

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Authors+Show Affiliations

Cheung JW
Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York 10021, USA. jac9029@med.cornell.edu
Chung JH
No affiliation info available
Ip JE
No affiliation info available
Markowitz SM
No affiliation info available
Liu CF
No affiliation info available
Thomas G
No affiliation info available
Lerman BB
No affiliation info available

MeSH

AdenosineAnti-Arrhythmia AgentsAtrial FibrillationCatheter AblationElectrocardiographyFemaleHumansMaleMiddle AgedPulmonary VeinsTreatment Outcome

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

22432847

Citation

Cheung, Jim W., et al. "Time Course of Adenosine-induced Pulmonary Vein Reconnection After Isolation: Implications for Mechanism of Dormant Conduction." Pacing and Clinical Electrophysiology : PACE, vol. 35, no. 5, 2012, pp. 556-63.
Cheung JW, Chung JH, Ip JE, et al. Time course of adenosine-induced pulmonary vein reconnection after isolation: implications for mechanism of dormant conduction. Pacing Clin Electrophysiol. 2012;35(5):556-63.
Cheung, J. W., Chung, J. H., Ip, J. E., Markowitz, S. M., Liu, C. F., Thomas, G., & Lerman, B. B. (2012). Time course of adenosine-induced pulmonary vein reconnection after isolation: implications for mechanism of dormant conduction. Pacing and Clinical Electrophysiology : PACE, 35(5), 556-63. https://doi.org/10.1111/j.1540-8159.2012.03356.x
Cheung JW, et al. Time Course of Adenosine-induced Pulmonary Vein Reconnection After Isolation: Implications for Mechanism of Dormant Conduction. Pacing Clin Electrophysiol. 2012;35(5):556-63. PubMed PMID: 22432847.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Time course of adenosine-induced pulmonary vein reconnection after isolation: implications for mechanism of dormant conduction. AU - Cheung,Jim W, AU - Chung,Jeffrey H, AU - Ip,James E, AU - Markowitz,Steven M, AU - Liu,Christopher F, AU - Thomas,George, AU - Lerman,Bruce B, Y1 - 2012/03/20/ PY - 2012/3/22/entrez PY - 2012/3/22/pubmed PY - 2012/9/20/medline SP - 556 EP - 63 JF - Pacing and clinical electrophysiology : PACE JO - Pacing Clin Electrophysiol VL - 35 IS - 5 N2 - BACKGROUND: Adenosine (ADO) has been proposed to reconnect isolated pulmonary veins (PVs) postablation through hyperpolarization of damaged myocytes in an animal model. However, PV reconnection can occur via ADO-mediated sympathetic activation. We sought to determine the mechanism of ADO-induced PV reconnection in the clinical setting by characterizing its time course and location in patients undergoing PV isolation. METHODS: Seventy-four patients (61 male; age 61 ± 10 years) undergoing PV isolation for atrial fibrillation (54 [73%] paroxysmal and 19 [27%] persistent) were studied. After each PV was isolated, a 12-mg intravenous bolus of ADO was administered and onset, offset, and location of ADO-induced PV reconnection and onset and offset of bradycardia were analyzed. RESULTS: In 22 (30%) patients, ADO-induced PV reconnection occurred in 34 of 270 (13%) PVs. In 24 (71%) PVs, the duration of ADO-induced reconnection exceeded that of bradycardia. The onset of ADO-induced reconnection occurred before the onset of bradycardia in 10 (30%) PVs and during bradycardia in 23 (70%) PVs. No PVs exhibited onset of reconnection after resolution of bradycardia. Common sites of PV reconnection included the carinal region (41% of right PVs and 29% of left PVs) and left PV-atrial appendageal ridge region (35% of left PVs). CONCLUSIONS: ADO-induced PV reconnection occurs during the bradycardic phase of the ADO bolus response and not during the late tachycardic phase. ADO-induced PV dormant conduction is closely associated with the negative dromotropic effects of ADO and suggests that hyperpolarization of the resting membrane is the unifying mechanism. SN - 1540-8159 UR - https://www.unboundmedicine.com/medline/citation/22432847/Time_course_of_adenosine_induced_pulmonary_vein_reconnection_after_isolation:_implications_for_mechanism_of_dormant_conduction_ L2 - https://doi.org/10.1111/j.1540-8159.2012.03356.x DB - PRIME DP - Unbound Medicine ER -