title: Determining the Optimal Dose of Adenosine for Unmasking Dormant Pulmonary Vein Conduction Following Atrial Fibrillation Ablation: Electrophysiological and Hemodynamic Assessment. DORMANT-AF Study.
abstract: ELECTROPHYSIOLOGICAL AND HEMODYNAMIC ASSESSMENT.
  
  
  
  The significance of adenosine induced dormant pulmonary vein (PV) conduction in atrial fibrillation (AF) ablation remains controversial. The optimal dose of adenosine to determine dormant PV conduction is yet to be systematically explored.
  
  
  
  ELECTROPHYSIOLOGICAL AND HEMODYNAMIC ASSESSMENT.
  
  
  
  Consecutive patients undergoing index AF ablation received 3 adenosine doses (12, 18, and 24 mg) in a randomized blinded order, immediately after pulmonary vein isolation (PVI). Electrophysiological (PR prolongation, AV block (AVB) and PV reconnection) and hemodynamic (BP) parameters were measured. A total, 339 doses (113/dose) assessed 191 PVs in 50 patients (66% male, 72% PAF, 52% hypertensive). Dormant PV conduction occurred in 28% of patients (16.5% [32] of PVs). All cases were associated with AVB (AVB: PV reconnection vs. no PV reconnection 100% vs. 83%, P = 0.007). AVB occurred more frequently at 24 mg versus 12 mg (92% vs. 82%, P = 0.019) but not versus 18 mg (91%, P = 0.62). AVB duration progressed between 12 mg (12.0 ± 8.9 seconds), 18 mg (16.1 ± 9.1 seconds, P = 0.001), and 24 mg (19.0 ± 9.3 seconds, P < 0.001) doses. MBP fell further at 24 mg (ΔMBP: 27 ± 12 mmHg) and 18 mg (26 ± 13 mmHg) doses compared to 12 mg (22 ± 10 mmHg vs., P < 0.001). A significant reduction in AVB in patients >110 kg (65% vs. 91% in 70-110 kg group, P < 0.001) in response to adenosine was seen.
  
  
  
  ELECTROPHYSIOLOGICAL AND HEMODYNAMIC ASSESSMENT.
  
  
  
  An adenosine dose producing AVB is required to unmask dormant PV conduction. AVB is significantly reduced in patients >110 kg. Weight and dosing variability may in part explain the conflicting results of studies evaluating the clinical utility of adenosine in PVI.
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Cabrini Health, Melbourne, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.|Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Prabhu
authors.affiliation: Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mackin
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Cabrini Health, Melbourne, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.|Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Alex J A
authors.initials: AJ
authors.lastname: McLellan
authors.affiliation: Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.|Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Tuong
authors.initials: T
authors.lastname: Phan
authors.affiliation: Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Desmond
authors.initials: D
authors.lastname: McGlade
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Cabrini Health, Melbourne, Victoria, Australia.|Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Liang-Han
authors.initials: LH
authors.lastname: Ling
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Kah Y
authors.initials: KY
authors.lastname: Peck
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Cabrini Health, Melbourne, Victoria, Australia.|Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.|Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Alexandr
authors.initials: A
authors.lastname: Voskoboinik
authors.affiliation: Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Bupesh
authors.initials: B
authors.lastname: Pathik
authors.affiliation: Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Chrishan J
authors.initials: CJ
authors.lastname: Nalliah
authors.affiliation: Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Geoff R
authors.initials: GR
authors.lastname: Wong
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Sonia M
authors.initials: SM
authors.lastname: Azzopardi
authors.affiliation: Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Mariani
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Cabrini Health, Melbourne, Victoria, Australia.|Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
authors.affiliation: Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.|Baker IDI Heart and Diabetes Institute, Cabrini Health, Melbourne, Victoria, Australia.|Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.|Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
mesh_terms: D000200:Action Potentials; D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D054537:Atrioventricular Block / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014739:Victoria
chemical_list: D000241:Adenosine
keywords: adenosine; atrial fibrillation; atrioventricular block; catheter ablation; dormant conduction; hemodynamic