title: Late re-conduction sites in the second session after pulmonary vein isolation using adenosine provocation for atrial fibrillation.
abstract: OBJECTIVE
  Intravenous adenosine triphosphate (ATP) administration could reveal dormant conduction (DC) gaps on the ablation line of a pulmonary vein isolation (PVI). We compared the ATP-provoked DC sites in the initial PVI with the PV re-conduction sites in the second session in patients with paroxysmal atrial fibrillation (AF).
  
  
  RESULTS
  We conducted a multicenter, observational study from a prospective registry undergoing AF ablation. A total of 110 consecutive drug-refractory paroxysmal AF patients were enroled in this study. Dormant conduction was detected by an ATP provocation of up to 40 mg during a continuous isoproterenol infusion (0.5-2 μg/min). The DC sites at each of the right and left PVs were precisely determined by using double spiral catheters under the guidance of a three-dimensional constructed anatomical mapping system. In the initial session, DC was observed in 35 patients (31.8%, 1.3 gaps/patient), and the sites of the DC were commonly observed in the carina region (43.5%). Atrial fibrillation recurrence was confirmed in 33 patients (30.0%) during follow-up (27.1 months), and a second session was performed in 24 of 33 patients (70.6%). In the second session, the re-conduction sites were also commonly observed in the carina region (59.5%).
  
  
  CONCLUSIONS
  The carina region was still a dominant re-conduction site even after the elimination of any ATP-provoked DC in the index procedure.
authors.affiliation: Department of Cardiovascular Medicine, Tenri Hospital, 200 Mishima, Tenri, Nara 632-8552, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kaitani
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kurotobi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobori
authors.forename: Katsunori
authors.initials: K
authors.lastname: Okajima
authors.forename: Takenori
authors.initials: T
authors.lastname: Yao
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakazawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
mesh_terms: D000200:Action Potentials; D000241:Adenosine / Q000008:administration & dosage; D061605:Administration, Intravenous; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000241:Adenosine
keywords: Adenosine; Atrial fibrillation; Carina region; Catheter ablation