title: Role of adenosine after antral pulmonary vein isolation of paroxysmal atrial fibrillation: A randomized controlled trial.
abstract: BACKGROUND
  Adenosine can reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). However, the impact of elimination of adenosine-provoked dormant PV conduction after PVI has not been formally evaluated.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether ablation of PV reconnections unmasked by adenosine improves outcomes.
  
  
  METHODS
  Patients with paroxysmal AF (n = 129) were randomized to receive either adenosine (n = 61) or no adenosine (n = 68) after PVI. Dormant conduction revealed by adenosine after PVI was ablated until all adenosine-mediated reconnections were eliminated. Thereafter, both groups received isoproterenol.
  
  
  RESULTS
  Acute reconnection was seen in 23 patients (37%) in the adenosine group. There was a significant difference between the number of PVs reconnected if patients were given adenosine >60 minutes after initial PVI compared to those who received adenosine <60 minutes after initial PVI (3/32 [9.4%] vs 24/32 [75%], P <.0001). Patients who did not receive adenosine had more PV reconnections after isoproterenol infusion compared to patients in the adenosine group (17/68 [25.0%] vs 5/61 [8.2%], P = .018). There was no difference in the rate of AF recurrence in patients who received adenosine (24/61 [39%]) compared to control patients (23/68 [34%], log-rank P = .83).
  
  
  CONCLUSIONS
  Adenosine can reveal dormant conduction in more than one-third of patients with paroxysmal AF undergoing PVI. However, adenosine administration, and additional ablation of the resultant connections, does not improve long-term outcomes compared to a protocol that includes isoproterenol infusion.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ghanbari
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ronak
authors.initials: R
authors.lastname: Jani
authors.affiliation: American University of the Caribbean, Cupecoy, Netherland Antilles.
authors.forename: Atheer
authors.initials: A
authors.lastname: Hussain-Amin
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Wassim
authors.initials: W
authors.lastname: Al-Assad
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Huether
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sardar
authors.initials: S
authors.lastname: Ansari
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Latchamsetty
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. Electronic address: achugh@umich.edu.
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007545:Isoproterenol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000241:Adenosine; D007545:Isoproterenol
keywords: Adenosine; Atrial fibrillation; Catheter ablation; Dormant conduction; Pulmonary vein