Impact of adenosine-provoked acute dormant pulmonary vein conduction on recurrence of atrial fibrillation.
BACKGROUND
Adenosine can be associated with acute recovery of conduction to the pulmonary veins (PVs) immediately after isolation. The objective of this study was to evaluate whether the response to adenosine predicts atrial fibrillation (AF) recurrence after a single ablation procedure in patients with paroxysmal AF.


RESULTS
A total of 109 consecutive patients (61 ± 10 years; 91 males) with drug-refractory paroxysmal AF who underwent AF ablation were analyzed. After PV antrum isolation (PVAI), dormant PV conduction was evaluated by an administration of adenosine in all patients. No acute reconnections were provoked by the adenosine in 70 (64.2%) patients (Group-1), but they were provoked in at least one side of the ipsilateral PVs in 39 (35.8%) patients (Group-2). All adenosine-provoked dormant conductions were successfully eliminated by additional ablation applications. By 12 months after the initial procedure, 72 (66.1%) patients were free of AF recurrences without any antiarrhythmic drugs. A Cox regression multivariate analysis of the variables including the adenosine-provoked reconductions, age, gender, duration of AF, presence of hypertension or structural heart disease, left atrial size, left ventricular ejection fraction, and body mass index demonstrated that adenosine-provoked reconductions were an independent predictor of AF recurrence after a single ablation procedure (hazard ratio: 1.387; 95% confidence interval: 1.018-1.889, P = 0.038). At the repeat session for recurrent AF, conduction recovery was observed similarly in both groups (P = 0.27).


CONCLUSIONS
Even after the elimination of any adenosine-provoked dormant PV conduction, the appearance of acute adenosine-provoked reconduction after the PVAI was an independent predictor of AF recurrence after a single AF ablation procedure.
Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahamadori, Yokosuka-shi, Kanagawa-ken, Japan. mshinsuke@k3.dion.ne.jp
Shinsuke
S
Miyazaki
Taishi
T
Kuwahara
Atsushi
A
Kobori
Yoshihide
Y
Takahashi
Asumi
A
Takei
Akira
A
Sato
Mitsuaki
M
Isobe
Atsushi
A
Takahashi
D000241:Adenosine / Q000494:pharmacology; D000255:Adenosine Triphosphate / Q000494:pharmacology; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery; D017115:Catheter Ablation; D016001:Confidence Intervals; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000187:drug effects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000187:drug effects*; D012008:Recurrence; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome
D000255:Adenosine Triphosphate; D000241:Adenosine