title: Unmasking the dormant pulmonary vein conduction with adenosine administration after pulmonary vein isolation with laser energy.
abstract: OBJECTIVE
  The isolation of the pulmonary veins (PVs) is the mainstay of atrial fibrillation (AF) ablation, which with current ablation techniques can be achieved in almost all cases. Reconnection of PVs constitutes the most frequent cause of AF recurrence. Visually guided laser balloon ablation (VGLA) is a novel system with very high rate of persistence of pulmonary vein isolation (PVI) three months after the first procedure shown in preclinical and clinical studies. We aimed to determine the acute efficiency of the laser energy during PVI with the help of adenosine provocation.
  
  
  RESULTS
  Twenty-six patients (19 male; mean age 64 ± 9 years) with symptomatic paroxysmal AF were included in the study. Pulmonary vein isolation was performed using the VGLA system. After successful PVI, we studied the effects of intravenous adenosine (18 mg) on activation of each PV at least 20 min after PVI. A total of 104 PVs were targeted. The balloon catheter could not be placed in two PVs. Of the remaining 102 PVs 99 (97% of the ablated PVs) could be successfully isolated. Adenosine was administered for each isolated PV in 25 patients. Only six PVs (6.7%) in five patients (20%) showed a PV reconnection during adenosine provocation.
  
  
  CONCLUSIONS
  Pulmonary vein isolation with VGLA is a feasible technique for PVI with a very effective acute lesion formation. The clinical significance of this low reconnection rate has to be determined.
authors.affiliation: University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany ekrem.uecer@ukr.de.
authors.forename: Ekrem
authors.initials: E
authors.lastname: Üçer
authors.affiliation: University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Fredersdorf
authors.affiliation: University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany.
authors.forename: Carsten Gerald
authors.initials: CG
authors.lastname: Jungbauer
authors.affiliation: University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Seegers
authors.affiliation: University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Debl
authors.affiliation: University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Riegger
authors.affiliation: University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany.
authors.forename: Lars Siegfried
authors.initials: LS
authors.lastname: Maier
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000241:Adenosine
keywords: Ablation; Adenosine; Atrial fibrillation; Endoscopic visualization; Laser; Reconnection