title: Clinical implications of reconnection between the left atrium and isolated pulmonary veins provoked by adenosine triphosphate after extensive encircling pulmonary vein isolation.
abstract: BACKGROUND
  Dormant pulmonary vein (PV) conduction can be provoked by adenosine triphosphate (ATP) after extensive encircling pulmonary vein isolation (EEPVI). However, the clinical implication of reconnection between the left atrium (LA) and isolated PVs provoked by ATP (ATP-reconnection) remains unknown.
  
  
  RESULTS
  We studied the clinical consequences of ATP-reconnection during intravenous isoproterenol infusion (ISP-infusion). EEPVI severs conduction between the LA and ipsilateral PVs at their junction. Radiofrequency energy is applied at a distance from the PV ostia guided by double Lasso catheters placed within the ipsilateral superior and inferior PVs. This study comprised 82 patients (67 men, 56 +/- 9 years old) with atrial fibrillation (AF) who underwent injection of ATP during ISP infusion after successful EEPVI (ATP(+) group). We compared clinical characteristics of 170 patients who underwent earlier EEPVI prior to our use of ATP injection after successful EEPVI (ATP(N/D) group) with those of ATP(+) group patients who underwent one session of EEPVI. ATP-reconnection occurred in 34 (41%) of 82 ATP(+) group patients. Additional radiofrequency applications were performed to eliminate ATP-reconnection in all ipsilateral PVs. Continuous ATP-reconnection of more than 20 seconds duration occurred in six (7.3%) of 82 patients. A total of 102 (60%) of 170 patients in the ATP(N/D) group had no recurrence of AF, whereas 60 (73%) of 82 ATP(+) group patients who underwent only one EEPVI session have had no recurrence of AF in a 6.1 +/- 3.3-month follow-up period (P = 0.04).
  
  
  CONCLUSIONS
  Radiofrequency application for provoked ATP-reconnection may reduce clinical AF recurrence.
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan. hh8814.cvm@tmd.ac.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Nagata
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Shingo
authors.initials: S
authors.lastname: Maeda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Mihoko
authors.initials: M
authors.lastname: Kawabata
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
mesh_terms: D000255:Adenosine Triphosphate / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D002316:Cardiotonic Agents / Q000008:administration & dosage; D017115:Catheter Ablation / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000187:drug effects* / Q000294:innervation* / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007545:Isoproterenol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D000255:Adenosine Triphosphate; D007545:Isoproterenol