title: Reappraisal of the clinical implications of adenosine triphosphate in terms of the prediction of reconnection sites in cases with electrical isolation of the pulmonary veins.
abstract: OBJECTIVE
  Dormant conduction (DC) induced by intravenous adenosine triphosphate (ATP) after pulmonary vein (PV) isolation (PVI) could predict subsequent PV reconnection (RC) sites. This study aimed to investigate the relationship between the DC and RC sites during the long-term follow-up.
  
  
  METHODS
  Ninety-one consecutive patients (62 males; mean age, 62 ± 11 years) with symptomatic persistent (n = 18) or paroxysmal (n = 73) atrial fibrillation (AF) who underwent PVI were included in this study. After a successful PVI, we administered ATP to reveal the DC sites. In total, DC sites were observed in 46 (51%) patients, and all were left un-ablated after marking or tagging all of them using fluoroscopic images and a three-dimensional (3D) mapping system. After the follow-up period (14.8 ± 3.6 months), AF recurred in 29 (32%) patients, all of whom had a DC in the initial ablation session, and underwent redo sessions. We divided the DC sites into three groups; in group A, the RC sites differed from the DC sites, in group B, the RC sites were identical to the DC sites, and in group C, the RC sites involved both DC and other sites.
  
  
  RESULTS
  As a result, 20 (69%), 3 (11.5%), and 6 (19.5%) patients belonged to groups A, B, and C, respectively. Statistical analyses comparing the agreement between DC and the RC sites yielded a weak relationship.
  
  
  CONCLUSIONS
  DC sites implying RC sites had a weak agreement, and other options to predict RC sites will be required to improve the clinical benefit of CA of AF.
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan. okishige@yo.rim.or.jp.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Okishige
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan.
authors.forename: Hideshi
authors.initials: H
authors.lastname: Aoyagi
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Ihara
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Iwai
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan.
authors.forename: Mitsumi
authors.initials: M
authors.lastname: Yamashita
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Katoh
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Heart Center, Yokohama-City Bay Red Cross Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama City, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Kawaguchi
authors.affiliation: Department of Cardiology, Edogawa Hospital, Tokyo, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Keida
authors.affiliation: Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sasano
authors.affiliation: Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
mesh_terms: D000255:Adenosine Triphosphate / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000187:drug effects*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000187:drug effects / Q000601:surgery*; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000255:Adenosine Triphosphate
keywords: Adenosine triphosphate; Atrial fibrillation; Catheter ablation; Dormant conduction