title: Clinical utility of adenosine-infusion test at a repeat atrial fibrillation ablation procedure.
abstract: BACKGROUND
  The majority of patients with recurrence of arrhythmia after the initial atrial fibrillation (AF) ablation procedure have resumption of pulmonary vein (PV) conduction. Adenosine-infusion test after PV isolation identifies acute dormant PV conduction during the index procedure.
  
  
  OBJECTIVE
  To evaluate the utility of adenosine-infusion test at a repeat AF ablation procedure.
  
  
  METHODS
  This study included 50 consecutive patients (38 men; mean age 65 ± 9 years) who underwent second ablation procedure for recurrent atrial tachyarrhythmia(s). At the index procedure, which was undertaken for paroxysmal AF, all patients underwent PV isolation and 48 of 50 (96%) underwent superior vena cava (SVC) isolation followed by adenosine infusion. PV and SVC were reisolated-if found reconnected-at the start of the second procedure. Thereafter, adenosine-infusion test was undertaken for all PVs in all patients.
  
  
  RESULTS
  At the index procedure, adenosine infusion revealed dormant PV conduction in 15 of 50 (30%) patients. At the second procedure, after 10 ± 10 months, PV and SVC reconnections were observed in 46 of 50 (92%) and 33 of 48 (68.8%) patients and they were reisolated. Subsequently, adenosine-infusion test revealed dormant PV conduction in 9 of 50 (18%) patients, including 3 of 50 (6%) who had no PV reconnection at the start of the procedure. In these 3 patients, transient AF resulted after adenosine infusion, and at mean 8.0 ± 3.4 months, they were free from any atrial arrhythmia after the elimination of dormant PV conduction alone.
  
  
  CONCLUSIONS
  Adenosine-infusion test reveals dormant thoracic vein conduction associated with arrhythmia recurrence in the chronic phase after the initial PV isolation.
authors.affiliation: 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: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Shah
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusa
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
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 / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery; D012008:Recurrence; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000503:physiopathology* / Q000601:surgery
chemical_list: D000241:Adenosine