Intravenous adenosine to predict conduction recurrence in cavotricuspid isthmus early after ablation of typical atrial flutter: myth or reality?
BACKGROUND
Early recovery of conduction (ER) after cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl) occurs in approximately 10% of the patients. If not recognized, ER might lead to AFl recurrences. In this study, we hypothesized that intravenous adenosine (iADO) can be used to predict ER in the CTI immediately after RF ablation and distinguish functional block from the complete destruction of the CTI myocardium.


METHODS
We prospectively included 68 consecutive patients (age: 65 ± 14 years; male: 78%) referred in our centers for AFl ablation. Immediately after bidirectional isthmus block validation, a bolus of iADO was given during continuous pacing from the proximal coronary sinus. Patients with functional block revealed under iADO (iADO+) and those without (iADO-) were subsequently observed for a 30-minute waiting period (ER-) or until sustained recovery of the conduction through the CTI (ER+).


RESULTS
Seven patients presented a persistent recovery (ER+, 10.3%, mean time to recovery: 14 ± 9 minutes). None of them presented even a transient resumption of conduction under iADO (iADO+: 0). With univariate analysis, we identified a heavy patient weight (>95 kg) as a predictor of ER (sensitivity: 71%).


CONCLUSIONS
Adenosine does not predict early recovery in the CTI after linear ablation for atrial flutter. We found that a patient weight over 95 kg predicted early recovery of conduction through the CTI with a sensitivity of 71%.
Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. sebastien.marchandise@uclouvain.be
Sébastien
S
Marchandise
Christophe
C
Scavée
Damien
D
Badot
Olivier
O
Deceuninck
Olivier
O
Xhaët
Pierre
P
Hausman
Christophe
C
De Meester
Jean-Benoît
JB
Le Polain De Waroux
D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001835:Body Weight; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*
D000241:Adenosine