Early detection of pulmonary vein reconnection after isolation in patients with paroxysmal atrial fibrillation: a comparison of ATP-induction and reassessment at 30 minutes postisolation.
BACKGROUND
Catheter ablation for paroxysmal AF (PAF) is limited by an unacceptable recurrence rate, mainly due to pulmonary vein (PV) reconnection. Strategies to minimize reconnection include adenosine infusion and also a waiting period of 30 minutes after PV isolation. The aim of the present study was to assess whether these two strategies revealed the same conduction gap.


RESULTS
In total, 88 consecutive patients (54 males, mean age of 60 years) with drug refractory PAF underwent circumferential PV isolation (CPVI). After isolation of ipsilateral PVs, with entry and exit block checked using a circular mapping catheter, 20 mg ATP was injected during isoproterenol infusion to reveal dormant conduction gap(s). Unless the reconnection revealed by ATP persisted, PVs were further remapped with the circular mapping catheter at 30 minutes postisolation. Totally, PV reconnection was observed in 56 (64%) patients. 24.3% veins (80/329) were found reconnected. Reassessment at 30 minutes postablation was more efficient as compared to ATP induction (19.8% vs 14.6% for ATP). The agreement between these 2 methods is moderate (kappa value = 0.50). In veins that transiently reconnected after ATP administration and later observed at 30 minutes postablation, 94% (17 of 19) of them were found being reconnected with the same gap.


CONCLUSIONS
Acute PV reconnection is common, occurring in 64% of patients, as detected by adenosine infusion and waiting time. Each shows a unique quality as compared to one another. The combined use of these 2 methods may reduce the AF recurrence rate after CPVI.
Jiang
Chen-Yang
CY
SIR RUN RUN SHAW Institute of Clinical Medicine of Zhejiang University, Hangzhou, China.
Jiang
Ru-Hong
RH
Matsuo
Seiichiro
S
Liu
Qiang
Q
Fan
You-Qi
YQ
Zhang
Zhu-Wen
ZW
Fu
Guo-Sheng
GS
D000241:Adenosine; D000255:Adenosine Triphosphate; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000517:prevention & control*; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D000255:Adenosine Triphosphate; D000241:Adenosine