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Adenosine Triphosphate Test After Cryothermal Pulmonary Vein Isolation: Creating Contiguous Lesions Is Essential for Eliminating Dormant Conduction.
J Cardiovasc Electrophysiol. 2015 Oct; 26(10):1069-74.JC

Abstract

BACKGROUND

Adenosine triphosphate (ATP) testing reveals dormant pulmonary vein (PV) conduction after electrical PV isolation (PVI). This study aimed to evaluate the incidence of latent PV conduction after cryothermal PVI.

METHODS

Fifty-four consecutive paroxysmal atrial fibrillation patients undergoing cryothermal PVI were prospectively enrolled. PVI was performed with one 28-mm second-generation balloon using a 3-minute freeze technique, and touch-up lesions were created by focal cryothermal applications. ATP testing was performed following PVI with a 20-mm circular mapping catheter placed in each PV.

RESULTS

Of 217 PVs, 205 (94.5%) were isolated using a cryoballoon, and 12 required additional focal ablation. ATP testing was performed in 46 patients for 173 and 8 PVs, which were isolated by cryoballoons and focal ablation, respectively. No dormant PV conduction was provoked in any PVs, which were isolated by cryoballoons, whereas 4 (50.0%) out of 8 PVs requiring focal ablation had transient ATP-provoked reconnections (0 vs. 50.0%, P < 0.0001) with a median duration of 11.3 (10.7-17.1) seconds. The latent PV conduction site was identical to the residual conduction gap site after cryoballoon ablation in all. All latent conduction was successfully eliminated by 2 (2.0-9.5) additional focal applications. At a mean follow-up of 7.7 ± 1.6 months, 81.5% of the patients were arrhythmia free after a single procedure.

CONCLUSIONS

No dormant PV conduction was provoked in PVs, which were isolated by 28-mm second-generation cryoballoons, but was provoked in 50% of PVs, which were isolated by focal cryoablation. These findings suggest that creating contiguous lesions is essential for eliminating dormant conduction in cryothermal ablation.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

MeSH

Adenosine TriphosphateAtrial FibrillationCatheter AblationCryosurgeryFemaleHeart Conduction SystemHumansIncidenceJapanMaleMiddle AgedMonitoring, IntraoperativePulmonary VeinsRecurrenceRisk FactorsTreatment Outcome

Pub Type(s)

Clinical Trial

Journal Article

Language

eng

PubMed ID

26076357

Citation

Miyazaki, Shinsuke, et al. "Adenosine Triphosphate Test After Cryothermal Pulmonary Vein Isolation: Creating Contiguous Lesions Is Essential for Eliminating Dormant Conduction." Journal of Cardiovascular Electrophysiology, vol. 26, no. 10, 2015, pp. 1069-74.

Miyazaki S, Taniguchi H, Nakamura H, et al. Adenosine Triphosphate Test After Cryothermal Pulmonary Vein Isolation: Creating Contiguous Lesions Is Essential for Eliminating Dormant Conduction. J Cardiovasc Electrophysiol. 2015;26(10):1069-74.

Miyazaki, S., Taniguchi, H., Nakamura, H., Hachiya, H., Ichihara, N., Araki, M., Kuroi, A., Takagi, T., Iwasawa, J., Hirao, K., & Iesaka, Y. (2015). Adenosine Triphosphate Test After Cryothermal Pulmonary Vein Isolation: Creating Contiguous Lesions Is Essential for Eliminating Dormant Conduction. Journal of Cardiovascular Electrophysiology, 26(10), 1069-74. https://doi.org/10.1111/jce.12726

Miyazaki S, et al. Adenosine Triphosphate Test After Cryothermal Pulmonary Vein Isolation: Creating Contiguous Lesions Is Essential for Eliminating Dormant Conduction. J Cardiovasc Electrophysiol. 2015;26(10):1069-74. PubMed PMID: 26076357.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Adenosine Triphosphate Test After Cryothermal Pulmonary Vein Isolation: Creating Contiguous Lesions Is Essential for Eliminating Dormant Conduction. AU - Miyazaki,Shinsuke, AU - Taniguchi,Hiroshi, AU - Nakamura,Hiroaki, AU - Hachiya,Hitoshi, AU - Ichihara,Noboru, AU - Araki,Makoto, AU - Kuroi,Akio, AU - Takagi,Takamitsu, AU - Iwasawa,Jin, AU - Hirao,Kenzo, AU - Iesaka,Yoshito, Y1 - 2015/08/03/ PY - 2015/03/30/received PY - 2015/05/17/revised PY - 2015/06/03/accepted PY - 2015/6/16/entrez PY - 2015/6/16/pubmed PY - 2016/7/29/medline KW - adenosine KW - atrial fibrillation KW - cryoablation KW - dormant conduction KW - pulmonary vein isolation SP - 1069 EP - 74 JF - Journal of cardiovascular electrophysiology JO - J Cardiovasc Electrophysiol VL - 26 IS - 10 N2 - BACKGROUND: Adenosine triphosphate (ATP) testing reveals dormant pulmonary vein (PV) conduction after electrical PV isolation (PVI). This study aimed to evaluate the incidence of latent PV conduction after cryothermal PVI. METHODS: Fifty-four consecutive paroxysmal atrial fibrillation patients undergoing cryothermal PVI were prospectively enrolled. PVI was performed with one 28-mm second-generation balloon using a 3-minute freeze technique, and touch-up lesions were created by focal cryothermal applications. ATP testing was performed following PVI with a 20-mm circular mapping catheter placed in each PV. RESULTS: Of 217 PVs, 205 (94.5%) were isolated using a cryoballoon, and 12 required additional focal ablation. ATP testing was performed in 46 patients for 173 and 8 PVs, which were isolated by cryoballoons and focal ablation, respectively. No dormant PV conduction was provoked in any PVs, which were isolated by cryoballoons, whereas 4 (50.0%) out of 8 PVs requiring focal ablation had transient ATP-provoked reconnections (0 vs. 50.0%, P < 0.0001) with a median duration of 11.3 (10.7-17.1) seconds. The latent PV conduction site was identical to the residual conduction gap site after cryoballoon ablation in all. All latent conduction was successfully eliminated by 2 (2.0-9.5) additional focal applications. At a mean follow-up of 7.7 ± 1.6 months, 81.5% of the patients were arrhythmia free after a single procedure. CONCLUSIONS: No dormant PV conduction was provoked in PVs, which were isolated by 28-mm second-generation cryoballoons, but was provoked in 50% of PVs, which were isolated by focal cryoablation. These findings suggest that creating contiguous lesions is essential for eliminating dormant conduction in cryothermal ablation. SN - 1540-8167 UR - https://www.unboundmedicine.com/medline/citation/26076357/Adenosine_Triphosphate_Test_After_Cryothermal_Pulmonary_Vein_Isolation:_Creating_Contiguous_Lesions_Is_Essential_for_Eliminating_Dormant_Conduction_ DB - PRIME DP - Unbound Medicine ER -