title: Adenosine administration during hybrid atrial fibrillation ablation to test dormant pulmonary vein conduction.
abstract: BACKGROUND
  Adenosine administration after initial pulmonary vein isolation (PVI) reveals dormant conduction and predicts atrial fibrillation (AF) recurrence. Elimination of dormant conduction when present may increase a long-term success rate of AF ablation procedures. There are no studies till date using adenosine to reveal acute reconduction of pulmonary veins (PVs) after epicardial PVI during a hybrid AF ablation procedure.
  
  
  METHODS
  We included 24 patients (21 male, 55 ± 9 years) undergoing hybrid ablation for symptomatic paroxysmal (n = 12) and persistent (n = 12) AF, using an epicardial bipolar radiofrequency clamp to perform PVI. All antiarrhythmic medications were discontinued 5 days prior to the procedure, except for patients on amiodarone. Thirty minutes after PVI and once sinus rhythm was obtained, a bolus of adenosine (12 to 36 mg) was administered intravenously. The subsequent response was assessed for each PV (n = 96) using an in situ circular mapping catheter.
  
  
  RESULTS
  Dormant conduction (i.e., the reappearance of PV potentials during at least one beat) was seen in 1 out of 96 PVs (1%). If reconduction was seen, further endocardial ablation using a 3.5-mm irrigated tip catheter was performed until no more reconduction occurred after repeating the adenosine bolus.
  
  
  CONCLUSIONS
  Adenosine administration after PVI with the use of an epicardial bipolar radiofrequency clamp in the setting of hybrid AF ablation reveals acute reconduction in 1% of the PVs.
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, PO Box 5800, Maastricht, The Netherlands. mindyvroomen1@gmail.com.
authors.forename: Mindy
authors.identifier: http://orcid.org/0000-0003-3473-9076
authors.initials: M
authors.lastname: Vroomen
authors.affiliation: Department of Cardiac Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.|Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: La Meir
authors.affiliation: Department of Cardiac Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, PO Box 5800, Maastricht, The Netherlands.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Crijns
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, PO Box 5800, Maastricht, The Netherlands.
authors.forename: Laurent
authors.initials: L
authors.lastname: Pison
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D004562:Electrocardiography / Q000187:drug effects* / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011667:Pulmonary Veins / Q000187:drug effects* / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000241:Adenosine
keywords: Ablation; Adenosine; Atrial fibrillation; Hybrid; Pulmonary vein isolation