title: 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.
abstract: 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.
authors: SIR RUN RUN SHAW Institute of Clinical Medicine of Zhejiang University, Hangzhou, China.
authors: Chen-Yang
authors: CY
authors: Jiang
authors: Ru-Hong
authors: RH
authors: Jiang
authors: Seiichiro
authors: S
authors: Matsuo
authors: Qiang
authors: Q
authors: Liu
authors: You-Qi
authors: YQ
authors: Fan
authors: Zhu-Wen
authors: ZW
authors: Zhang
authors: Guo-Sheng
authors: GS
authors: Fu
mesh_terms: 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
chemical_list: D014665:Vasodilator Agents; D000255:Adenosine Triphosphate; D000241:Adenosine