title: Adenosine testing after second-generation balloon devices (cryothermal and laser) mediated pulmonary vein ablation for atrial fibrillation.
abstract: OBJECTIVE
  Adenosine administration after pulmonary vein (PV) isolation using radiofrequency and cryoablation can cause acute recovery of conduction to the PVs and predicts atrial fibrillation (AF) recurrence. This study evaluated whether adenosine testing after second-generation balloon devices (cryothermal and laser) could reveal dormant PV reconduction and recurrence rate of AF.
  
  
  METHODS
  Out of total 60 patients, 20 patients underwent PV isolation using laser balloon and for the remaining patients, the cryoballoon was used. Following PVI, waiting period of 30 min was obtained. Thereafter, a bolus 15-21 mg of adenosine was injected followed by rapid saline flush. The subsequent response was assessed for each vein using an in situ lasso catheter. Further ablation (if needed) using laser balloon and cryocatheter respectively was done, until no reconduction occurred after repeat adenosine.
  
  
  RESULTS
  Acute PV isolation was achieved in all 80 PVs of 20 patients (100 %) using laser device and in 151 PVs (96.2 %) of 38 patients (95 %) using cryoballoon. However, in seven patients (35 %), 11 PVs (13.7 %) (4 LSPV, 2 LIPV, 4 RSPV, and 1 RIPV) showed dormant PV potentials after adenosine administration in laser group. Cryoballoon group showed dormant reconduction in four patients (10 %), four PVs (5 %) [one LSPV, one LIPV, and two RIPV]. The follow-up of 337 ± 92.4 days for cryoballoon and 267 ± 76.9 days for laser balloon group demonstrated similar success rates (85 %).
  
  
  CONCLUSIONS
  Adenosine testing after PV isolation using second-generation balloon based energy devices (laser and cryothermal) reveals dormant conduction in initially isolated PVs with similar long-term success rate.
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, PO Box 6229HX, Maastricht, The Netherlands, drnarendra007kr@gmail.com.
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.forename: Yuri
authors.initials: Y
authors.lastname: Blaauw
authors.forename: Carl
authors.initials: C
authors.lastname: Timmermans
authors.forename: Laurent
authors.initials: L
authors.lastname: Pison
authors.forename: Kevin
authors.initials: K
authors.lastname: Vernooy
authors.forename: Harry
authors.initials: H
authors.lastname: Crijns
mesh_terms: D000241:Adenosine; D000889:Anti-Arrhythmia Agents; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000241:Adenosine