title: Adenosine testing after cryoballoon pulmonary vein isolation improves long-term clinical outcome.
abstract: BACKGROUND
  Adenosine infusion after pulmonary vein isolation (PVI) with radiofrequency energy reveals dormant muscular sleeves and predicts atrial fibrillation (AF) recurrence. The aim of our study was to determine whether adenosine could reveal dormant PV sleeves after cryoballoon isolation and study its effect on long-term recurrence of AF.
  
  
  METHODS
  Patients with paroxysmal AF underwent cryoballoon PVI. After PVI, adenosine 25 mg was infused to test for dormant muscular sleeves in each vein. If reconnection under adenosine was shown, further cryoballoon ablation was performed until no more reconnection occurred. Follow-up was performed with ECG, 24-h Holter recording, and a symptom questionnaire at three monthly intervals. Transtelephonic Holter monitoring was performed for 1 month before and 3 months after PVI. Patients who underwent cryoballoon PVI without adenosine administration were used as controls for comparison.
  
  
  RESULTS
  In the study group (n = 34, 24 males), adenosine revealed dormant sleeves in 9/132 (8 %) veins, and 7/34 (21 %) patients. All but one vein was further treated until the dormant sleeves were isolated. During a mean follow-up of 520 ± 147 days, 23/34 (68 %) patients were free of AF without antiarrhythmic drugs (AADs). In the control group (n = 65, 46 males), 29/65 (46 %) were free of AF without AADs. There were significantly less AF recurrences in the study group (p = 0.04).
  
  
  CONCLUSIONS
  Adenosine administration after cryoballoon PVI reveals dormant muscular sleeves in 21 % of patients. Clinical follow-up shows that adenosine testing is effective in reducing AF recurrence after cryoballoon ablation.
authors.affiliation: Clinical Electrophysiology Unit, Department of Cardiology, Thoraxcentre, Erasmus University Rotterdam, 's Gravendijkwal 230., 3015 CE, Rotterdam, the Netherlands, yvesvanbelle@gmail.com.
authors.forename: Y L E
authors.initials: YL
authors.lastname: Van Belle
authors.forename: P A
authors.initials: PA
authors.lastname: Janse
authors.forename: N M S
authors.initials: NM
authors.lastname: de Groot
authors.forename: W
authors.initials: W
authors.lastname: Anné
authors.forename: D A M J
authors.initials: DA
authors.lastname: Theuns
authors.forename: L J
authors.initials: LJ
authors.lastname: Jordaens