Usefulness of the adenosine triphosphate with a sufficient observation period for detecting reconduction after pulmonary vein isolation.
BACKGROUND
Although reconduction after pulmonary vein (PV) isolation is considered to play a key role in the recurrence of paroxysmal atrial fibrillation (AF), there have been few reports regarding the precise time course of early reconduction. Several studies have suggested that transient PV reconduction facilitated by adenosine may predict long-term AF recurrence. This study was designed to clarify the incidence and time course of early reconduction after PVI during the procedure and to confirm whether the use of ATP after a certain observation period was useful to detect early reconduction after PVI.


METHODS
In 21 patients (18 males, 56 +/- 11 years) with drug refractory AF, radiofrequency circumferential PV antrum ablation was performed in all 4 PVs. After the completion of isolation, electrograms in each PV were repeatedly recorded (1.98 +/- 0.57 times per PV) using a circular mapping catheter for an observation period of 87 +/- 29 minutes. After isolation of all 4 PVs, 30 mg of adenosine triphosphate (ATP) was administered during isoproterenol infusion.


RESULTS
PV electrical isolation was initially achieved in all 81 PVs. During the observation period, 12 (15%) PVs in 10 (48%) of 21 patients exhibited spontaneous reconduction. Among the remaining 69 PVs, 8 (12%) additional PVs had reconduction with the use of ATP. All PV reconduction was successfully eliminated by 4.5 +/- 2.2 additional radiofrequency applications.


CONCLUSIONS
A sufficient observation period and the use of ATP are useful to detect early reconduction after PV isolation.
Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Yuichi
Y
Ninomiya
Yasuhisa
Y
Iriki
Sanemasa
S
Ishida
Naoya
N
Oketani
Takehiko
T
Matsushita
Hitoshi
H
Ichiki
Hideki
H
Okui
Tetsuro
T
Kataoka
Akiko
A
Yoshikawa
Masakazu
M
Ogawa
Keishi
K
Saihara
Takuro
T
Shinsato
Masaaki
M
Miyata
Shuichi
S
Hamasaki
Chuwa
C
Tei
D000255:Adenosine Triphosphate; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011667:Pulmonary Veins / Q000187:drug effects / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000255:Adenosine Triphosphate