Reduction of AF recurrence after pulmonary vein isolation by eliminating ATP-induced transient venous re-conduction.
BACKGROUND
Recent evidence has suggested that the transient re-conduction of the isolated pulmonary vein (PV) induced by the intravenous injection of adenosine (dormant PV conduction) might predict the incidence of subsequent venous reconnection after the procedure, which is the main cause of the atrial fibrillation (AF) recurrence after PV isolation (PVI). We tested the hypothesis that the elimination of these dormant PV conductions by additional radiofrequency (RF) applications can improve the efficacy of the PVI.


RESULTS
One hundred forty-eight patients (124 males; mean age 53 +/- 9 years) with drug-refractory AF underwent the PVI procedure. The standard PVI was performed in 94 patients (Group A), whereas the elimination of adenosine triphosphate (ATP)-induced dormant conduction using additional RF energy was performed in addition to the standard PVI in other 54 patients (Group B). Dormant conduction was observed in 56% of the patients (30/54) in Group B and 95% of these transient re-conductions were successfully eliminated by additional RF applications (mean: 1.5 +/- 1.0 times). During the mean follow-up period of 20 months, recurrences of AF after the procedures were observed significantly less frequently in Group B (20%) than in Group A (40%) (P < 0.05).


CONCLUSIONS
The use of additional RF applications to eliminate transient PV reconnection induced by ATP injection led to a reduction of AF recurrence after PVI, most likely due to the minimization of the subsequent PV reconnection.
Matsuo
Seiichiro
S
Department of Cardiology, Jikei University School of Medicine, Tokyo, Japan.
Yamane
Teiichi
T
Date
Taro
T
Inada
Keiichi
K
Kanzaki
Yasuko
Y
Tokuda
Michifumi
M
Shibayama
Kenri
K
Miyanaga
Satoru
S
Miyazaki
Hidekazu
H
Sugimoto
Kenichi
K
Mochizuki
Seibu
S
D000255:Adenosine Triphosphate; D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000187:drug effects* / Q000502:physiology; D012189:Retrospective Studies
D000255:Adenosine Triphosphate