title: Adenosine Triphosphate Test After Cryothermal Pulmonary Vein Isolation: Creating Contiguous Lesions Is Essential for Eliminating Dormant Conduction.
abstract: BACKGROUND
  Adenosine triphosphate (ATP) testing reveals dormant pulmonary vein (PV) conduction after electrical PV isolation (PVI). This study aimed to evaluate the incidence of latent PV conduction after cryothermal PVI.
  
  
  METHODS
  Fifty-four consecutive paroxysmal atrial fibrillation patients undergoing cryothermal PVI were prospectively enrolled. PVI was performed with one 28-mm second-generation balloon using a 3-minute freeze technique, and touch-up lesions were created by focal cryothermal applications. ATP testing was performed following PVI with a 20-mm circular mapping catheter placed in each PV.
  
  
  RESULTS
  Of 217 PVs, 205 (94.5%) were isolated using a cryoballoon, and 12 required additional focal ablation. ATP testing was performed in 46 patients for 173 and 8 PVs, which were isolated by cryoballoons and focal ablation, respectively. No dormant PV conduction was provoked in any PVs, which were isolated by cryoballoons, whereas 4 (50.0%) out of 8 PVs requiring focal ablation had transient ATP-provoked reconnections (0 vs. 50.0%, P < 0.0001) with a median duration of 11.3 (10.7-17.1) seconds. The latent PV conduction site was identical to the residual conduction gap site after cryoballoon ablation in all. All latent conduction was successfully eliminated by 2 (2.0-9.5) additional focal applications. At a mean follow-up of 7.7 ± 1.6 months, 81.5% of the patients were arrhythmia free after a single procedure.
  
  
  CONCLUSIONS
  No dormant PV conduction was provoked in PVs, which were isolated by 28-mm second-generation cryoballoons, but was provoked in 50% of PVs, which were isolated by focal cryoablation. These findings suggest that creating contiguous lesions is essential for eliminating dormant conduction in cryothermal ablation.
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Ichihara
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Araki
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Kuroi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Iwasawa
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
mesh_terms: D000255:Adenosine Triphosphate; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D003452:Cryosurgery / Q000706:statistics & numerical data*; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects / Q000601:surgery; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000706:statistics & numerical data; D011667:Pulmonary Veins / Q000187:drug effects / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000255:Adenosine Triphosphate
keywords: adenosine; atrial fibrillation; cryoablation; dormant conduction; pulmonary vein isolation