title: Clinical implication of adenosine test at repeat atrial fibrillation ablation procedure: the importance of detecting dormant thoracic vein conduction.
abstract: BACKGROUND
  Pulmonary vein reconnection after electrical isolation is commonly observed in the context of atrial fibrillation ablation and is associated with recurrent atrial tachyarrhythmias. Adenosine test was been performed to identify acute dormant conduction immediately after pulmonary vein isolation at index procedure. However, the utility of adenosine test at repeat procedure has not been reported.
  
  
  RESULTS
  We report 5 paroxysmal atrial fibrillation cases without any structural heart disease in which dormant thoracic vein conduction was associated with recurrent atrial tachyarrhythmias. All patients had undergone circumferential ipsilateral pulmonary vein isolation at the index procedure. Superior vena cava isolation was performed if superior vena cava-triggered atrial fibrillation was identified. At the index procedure, adenosine test did not provoke venous reconduction. At the repeat procedure, adenosine provoked clinical arrhythmia in 4 out of 5 cases after transient reconnection between culprit thoracic vein and atrium despite absence of reconnection at the start of the procedure. After the elimination of the dormant conduction gaps, all patients were free from recurrent arrhythmia.
  
  
  CONCLUSIONS
  Adenosine provokes dormant thoracic vein conduction associated with the late recurrence of atrial tachyarrhythmias after previous thoracic vein isolation. Thus, adenosine provocation test can specifically help identify and target the cause of recurrent atrial arrhythmia.
authors.affiliation: Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan. mshinsuke@k3.dion.ne.jp
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobori
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
mesh_terms: D000241:Adenosine; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D012307:Risk Factors; D013909:Thorax / Q000098:blood supply*; D016896:Treatment Outcome; D014680:Veins / Q000503:physiopathology* / Q000601:surgery; D014683:Vena Cava, Superior / Q000601:surgery
chemical_list: D000241:Adenosine