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Iqbal M, Jena A, Park HS, Baek YS, Lee KN, Roh SY, Shim JM, Choi JI, Kim YH. Value of adenosine test to reveal dormant conduction or adenosine-induced atrial fibrillation after pulmonary vein isolation. J Arrhythm 2017; 33:602-607. [PMID: 29255508 PMCID: PMC5728995 DOI: 10.1016/j.joa.2017.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/03/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022] Open
Abstract
Background Recent studies investigating the implications of additional ablation guided by dormant pulmonary vein (PV) conduction testing using adenosine showed conflicting results, and the data about atrial fibrillation (AF) recurrence after trigger site elimination in adenosine-induced AF are still lacking. Methods Of 846 patients with paroxysmal AF (PAF) who underwent PV isolation (PVI), adenosine test after PVI was performed in 148 patients. Results PVI was successfully achieved in 846 patients. We excluded 58 patients due to loss to the follow-up. A higher rate of AF recurrence was found in the group without adenosine test (136/644, 21%) compared to the group with adenosine test (20/144, 13%, log-rank P=0.047). In multivariate analysis model for AF freedom during the follow-up period, the only significant clinical predictor of AF freedom was adenosine test (hazard ratio [HR] 1.97; 95% confidence interval [CI]: 1.2-3.23; P=0.007).Among 148 patients with adenosine test, 114 (77%) patients showed neither dormant conductions nor AF-induced, 22 (15%) showed positive dormant conductions only, and 12 (8%) revealed adenosine-induced AF (6 of them also showed dormant conduction). After additional ablation in positive dormant conduction group and adenosine-induced AF group, AF recurrence was noted in 4/21 (19%) patients in positive dormant conduction group and 2/11 (18%) patients in adenosine-induced AF group, which was not different from that of patients in negative dormant conduction/ no AF-induced group (14/112, 12%, log-rank P=0.67). Conclusions Adenosine test after PVI to confirm the absence of dormant conduction and triggers initiating AF is beneficial to improve the outcomes after catheter ablation of PAF.
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Affiliation(s)
- Mohammad Iqbal
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea.,Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Jalan Eyckman 38, Bandung 40161, Indonesia
| | - Anupam Jena
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Hee-Soon Park
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Jae-Min Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
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Luni FK, Khan AR, Singh H, Riaz H, Malik SA, Khawaja O, Farid T, Cummings J, Taleb M. Identification and Ablation of Dormant Conduction in Atrial Fibrillation Using Adenosine. Am J Med Sci 2017; 355:27-36. [PMID: 29289258 DOI: 10.1016/j.amjms.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 09/05/2017] [Accepted: 09/18/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Ablation is used for treatment of atrial fibrillation (AF) but recurrence is common. Dormant conduction is hypothesized to be responsible for these recurrences, and the role of adenosine in identification and ablation of these pathways is controversial with conflicting results on AF recurrence. MATERIALS AND METHODS We conducted a meta-analysis for studies evaluating AF ablation and adenosine use. Included in the meta-analysis were human studies that compared ablation using adenosine or adenosine triphosphate (ATP) and reported freedom from AF in patients beyond a minimum follow-up of 6 months. RESULTS Our analysis suggests that the use of adenosine leads to a decrease in recurrence of AF compared to the cohort which did not utilize adenosine. Subgroup analysis showed no difference in the recurrence of AF with the modality used for ablation (cryoablation vs. radiofrequency ablation) or with the preparation of adenosine used (ATP vs. adenosine). There was a significant benefit in delayed administration of ATP over early administration. Pooling results of only randomized control trials did not show any significant difference in AF recurrence. CONCLUSIONS Adenosine-guided identification and ablation of dormant pathways may lead to a decrease in recurrence of AF.
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Affiliation(s)
- Faraz Khan Luni
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio.
| | - Abdur Rahman Khan
- Department of Cardiovascular Diseases, University of Louisville, Louisville, Kentucky
| | - Hemindermeet Singh
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Haris Riaz
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sonia Ali Malik
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Owais Khawaja
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Talha Farid
- Department of Cardiovascular Diseases, University of Louisville, Louisville, Kentucky
| | - Jennifer Cummings
- Department of Cardiovascular Diseases, Northeastern Ohio Medical University, Canton, Ohio
| | - Mohammed Taleb
- Department of Cardiovascular Diseases and Department of Family Medicine, Mercy Saint Vincent Medical Center, Toledo, Ohio
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. J Arrhythm 2017; 33:369-409. [PMID: 29021841 PMCID: PMC5634725 DOI: 10.1016/j.joa.2017.08.001] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Key Words
- AAD, antiarrhythmic drug
- AF, atrial fibrillation
- AFL, atrial flutter
- Ablation
- Anticoagulation
- Arrhythmia
- Atrial fibrillation
- Atrial flutter
- Atrial tachycardia
- CB, cryoballoon
- CFAE, complex fractionated atrial electrogram
- Catheter ablation
- LA, left atrial
- LAA, left atrial appendage
- LGE, late gadolinium-enhanced
- LOE, level of evidence
- MRI, magnetic resonance imaging
- OAC, oral anticoagulation
- RF, radiofrequency
- Stroke
- Surgical ablation
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Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Wang N, Phan S, Kanagaratnam A, Kumar N, Phan K. Adenosine Testing After Atrial Fibrillation Ablation: Systematic Review and Meta-Analysis. Heart Lung Circ 2017; 27:601-610. [PMID: 28655535 DOI: 10.1016/j.hlc.2017.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). We performed a systematic review and meta-analysis to assess the impact of adenosine administration in patients undergoing PVI for AF. METHODS Meta-analysis of 22 studies was performed to assess the rates of freedom from AF in 1) patients with dormant PV conduction versus patients without dormant PV conduction, and 2) patients given routine adenosine post PVI versus patients not given adenosine. Relative-risks (RR) were calculated using random effects modelling. RESULTS In 18 studies, 3038 patients received adenosine and freedom from AF in those patients with dormant PV reconnection was significantly lower (62.9%) compared to patients without PV reconnection (67.2%) (RR 0.87; 95% CI: 0.78-0.98). In seven studies with 3049 patients, the freedom from AF was significantly higher in patients who received adenosine (67%) versus those patients who did not receive adenosine (63%) (RR: 1.11; 95% CI: 1.01-1.22). CONCLUSIONS The present study showed clear benefits of adenosine testing for freedom from AF recurrence. Adenosine-guided dormant conduction is associated with higher AF recurrence despite further ablation. Future studies should investigate the optimal methodology, including dosage and waiting time between PVI and adenosine administration.
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Affiliation(s)
- Nelson Wang
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia.
| | - Steven Phan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia
| | | | - Narendra Kumar
- Department of Cardiology, Paras HMRI Hospitals, Raja Bazar, Patna, India
| | - Kevin Phan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia
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Bhatt AG, Mittal S. The waiting period following cavotricuspid isthmus ablation: Opportunity for watchful observation or a waste of time? J Cardiovasc Electrophysiol 2017; 28:882-884. [PMID: 28543927 DOI: 10.1111/jce.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Advay G Bhatt
- Arrhythmia Institute of the Valley Health System, Ridgewood, NJ, USA
| | - Suneet Mittal
- Arrhythmia Institute of the Valley Health System, Ridgewood, NJ, USA
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Bortone A, Lagrange P, Cauchemez B, Durand C, Dieuzaide P, Prévot S, Mechulan A, Pambrun T, Martin R, Parlier P, Masse A, Marijon E, Albenque JP. Elimination of the negative component of the unipolar electrogram as a local procedural endpoint during paroxysmal atrial fibrillation catheter ablation using contact-force sensing: the UNIFORCE study. J Interv Card Electrophysiol 2017. [PMID: 28643171 DOI: 10.1007/s10840-017-0264-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Elimination of the negative component of the unipolar atrial electrogram is a reliable indicator of the creation of a transmural lesion. Contact-force (CF) sensing technology has the potential to increase the durability of pulmonary vein isolation (PVI). In the present multicenter study, we assessed the 2-year sinus rhythm (SR) maintenance rate in patients with paroxysmal atrial fibrillation (PAF) after PVI guided by these two approaches. METHODS Two hundred fifteen consecutive PAF patients (62.1 ± 10.1 years, 65 women) were prospectively enrolled. All patients underwent PVI under CARTO guidance according to a systematic contiguous "point-by-point" approach, using radiofrequency energy, and a CF externally irrigated ablation catheter with the goal of at least 10g (ideally 20g) of force. The ablation endpoint of each individual lesion was elimination of the negative component of the unipolar atrial signal. The procedural endpoint was PVI with bidirectional block. RESULTS All PVs were successfully isolated. After 30 min of waiting time, 35 patients (16%) had PV reconnection and in all of them, the PVs were re-isolated. Two years after a single ablation procedure, 187 patients (87%) remained arrhythmia free, without anti-arrhythmic drugs. Of the 28 patients presenting with AF recurrence, 25 had PV reconnection and underwent repeat PVI while in the remaining 3 patients, all four PVs were isolated and extra-PV triggers were identified. There were six groin hematomas and one transient ischemic attack. CONCLUSIONS Unipolar atrial signal analysis combined with CF sensing ensures a robust 2-year SR maintenance rate in the treatment of PAF. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02520960.
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Affiliation(s)
- Agustín Bortone
- Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.
| | | | - Bruno Cauchemez
- Service de Rythmologie, Clinique Ambroise Paré, Neuilly sur Seine, France
| | - Cyril Durand
- Département de Rythmologie, Infirmerie Protestante, Lyon, France
| | - Pierre Dieuzaide
- Département de Rythmologie, Hôpital Privé Clairval, Marseille, France
| | - Sébastien Prévot
- Département de Rythmologie, Hôpital Privé Clairval, Marseille, France
| | - Alexis Mechulan
- Département de Rythmologie, Hôpital Privé Clairval, Marseille, France
| | - Thomas Pambrun
- Service de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France.,LYRIC Institute/INSERM 1045, University Hospital Haut-Leveque, Bordeaux, France
| | - Ruairidh Martin
- LYRIC Institute/INSERM 1045, University Hospital Haut-Leveque, Bordeaux, France
| | - Pauline Parlier
- Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France
| | - Alexandre Masse
- Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
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McLellan AJ, Kumar S, Smith C, Ling LH, Prabhu S, Kalman JM, Kistler PM. The role of adenosine challenge in catheter ablation for atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2017; 236:253-261. [DOI: 10.1016/j.ijcard.2017.01.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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Cha MJ, Choi EK, Oh S. Comparison between local and systemic injection of adenosine for detecting dormant conduction after PV isolation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:762-769. [PMID: 28543103 DOI: 10.1111/pace.13111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/14/2017] [Accepted: 04/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adenosine administration after pulmonary vein (PV) isolation is effective for identifying dormant conduction (DC). We aimed to compare the efficacy and safety of local injection of adenosine into the PV with systemic intravenous injection. METHODS After complete PV isolation was performed, adenosine was injected directly into the PV (local method, 6-18 mg) and the femoral vein (systemic method, 12-30 mg) sequentially. We compared the incidence of DC and the hemodynamic effect of adenosine between the methods. RESULTS We analyzed 150 PVs in 40 patients who underwent atrial fibrillation ablation. A total of 16 DCs were seen in 14 patients with either the local or systemic method. Among them, two DCs were detected only by the local method (detection rate: local 10.7% vs systemic 9.3%). The effective doses of adenosine required to induce atrioventricular (AV) block or detect DC were 7.7 ± 3.1 mg (local) and 13.1 ± 3.4 mg (systemic), respectively (P < 0.001). The time interval between adenosine injection and AV block was shorter with the local than systemic method (5.8 seconds vs 11.7 seconds, P < 0.001). Six DCs (four with local and two with systemic method) were detected without manifested AV block. Additionally, there were fewer decrements in blood pressure with the local than systemic method. CONCLUSION Local adenosine injection via the PV was comparable to systemic administration for detecting DC after PV isolation. Furthermore, the local method required a smaller dose of adenosine, took less time to induce AV block, and resulted in less systemic hemodynamic compromise than did the systemic method.
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Affiliation(s)
- Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Chen YH, Lin H, Xie CL, Hou JW, Li YG. Role of adenosine-guided pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a meta-analysis. Europace 2017; 19:552-559. [PMID: 28431050 DOI: 10.1093/europace/euw201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/08/2016] [Indexed: 10/13/2023] Open
Abstract
AIMS Adenosine had been reported to unmask dormant conduction and thus identify pulmonary vein at risk of reconnection. However, the role of adjunctive adenosine infusion after pulmonary vein isolation (PVI) on long-term arrhythmia-free survival was still contentious. The purpose of the present meta-analysis was to assess the association of adenosine testing with long-term ablation success in patients with atrial fibrillation (AF) (i.e. freedom from AF recurrence). METHODS AND RESULTS We systematically searched the electronic databases and finally included 10 studies, with 1771 patients undergoing adenosine-guided PVI and 1787 patients undergoing conventional PVI. In comparison to conventional PVI alone, adenosine-guided PVI improved the arrhythmia-free survival by 17% during a median follow-up of 12 months [relative risk (RR): 1.17; 95% confidence interval (CI): 1.07 to 1.27; P = 0.014]. Patients undergoing adenosine-guided PVI had similar fluoroscopy time to those who undergoing conventional PVI [weighted mean difference (WMD): 1.76; 95% CI: -5.66 to 9.17; P = 0.64], despite longer procedure time (WMD: 20.6; 95% CI: 0.70 to 40.50; P = 0.042). CONCLUSION From the available data of clinical studies, adenosine-guided PVI was associated with an increased arrhythmia-free survival when compared with conventional PVI in patients undergoing catheter ablation for AF.
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Affiliation(s)
- Yi-He Chen
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Hui Lin
- Department of Respiratory, The Second Af?liated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Cheng-Long Xie
- Department of Neurology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, Shanghai 200092, China
| | - Jian-Wen Hou
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
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Letsas KP, Georgopoulos S, Efremidis M, Liu T, Bazoukis G, Vlachos K, Karamichalakis N, Lioni L, Sideris A, Ehrlich JR. Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials. J Arrhythm 2017; 33:247-255. [PMID: 28765753 PMCID: PMC5529608 DOI: 10.1016/j.joa.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/16/2017] [Accepted: 02/19/2017] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The prognostic significance of adenosine-mediated dormant pulmonary vein conduction, and whether such dormant conduction should be eliminated, remains controversial. We sought to perform a meta-analysis of data from eligible studies to delineate the prognostic impact of adenosine-guided radiofrequency catheter ablation of atrial fibrillation. METHODS A systematic literature search was performed using online databases in order to identify relevant studies from January 2004 to September 2016. Ten studies [six observational and four randomized control trials (RCTs)] were included in the analysis. RESULTS Five studies (two observational and three RCTs) compared the efficacy of adenosine-mediated elimination of dormant conduction versus no adenosine test. Overall, the adenosine-guided ablation strategy displayed better long-term outcomes as compared with no adenosine testing (RR 1.08, 95% CI 1.01-1.14, p=0.02; Heterogeneity: I2=42%, p: 0.14). The meta-analysis of only RCTs failed to show any differences between the two strategies (RR 1.03, 95% CI 0.96-1.11, p=0.37; Heterogeneity: I2 0%, p: 0.41). Eight studies (five observational and three RCTs) addressed the efficacy of adenosine-induced dormant conduction and additional ablation versus no dormant conduction during adenosine challenge. Overall, a trend towards a better outcome in those without dormant conduction during drug challenge was noted (RR 0.89, 95% CI 0.77-1.03, p=0.11; Heterogeneity: I2 65% p: 0.006). The pooled analysis of RCTs failed to show any differences between the two arms (RR 0.90, 95% CI 0.62-1.30, p= 0.57; Heterogeneity: I2 88%, p: 0.0002). CONCLUSIONS Adenosine-guided radiofrequency catheter ablation of atrial fibrillation does not provide additional benefit in terms of freedom of arrhythmia recurrence.
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Affiliation(s)
- Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Stamatis Georgopoulos
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Michael Efremidis
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People׳s Republic of China
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Konstantinos Vlachos
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | | | - Louiza Lioni
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
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Pedrote A, Acosta J, Jáuregui-Garrido B, Frutos-López M, Arana-Rueda E. Paroxysmal atrial fibrillation ablation: Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions. World J Cardiol 2017; 9:230-240. [PMID: 28400919 PMCID: PMC5368672 DOI: 10.4330/wjc.v9.i3.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Pulmonary vein isolation by point-by-point radiofrequency catheter ablation constitutes the cornerstone of catheter ablation strategies for the treatment of atrial fibrillation. However, despite advances in pulmonary vein isolation ablation strategies, long-term success rates after ablation remain suboptimal, which highlights the need to develop techniques to achieve more durable lesions. Strategies proposed to improve the durability of pulmonary vein isolation can be divided into two groups: Those addressed to improving the quality of the lesion and those that optimize the detection of acute PV reconnection during the ablation procedure. This manuscript reviews the role and potential benefits of these techniques according to current clinical evidence.
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Adenosine administration during hybrid atrial fibrillation ablation to test dormant pulmonary vein conduction. J Interv Card Electrophysiol 2017; 49:59-65. [PMID: 28285383 PMCID: PMC5403878 DOI: 10.1007/s10840-017-0239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/01/2017] [Indexed: 11/22/2022]
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.
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Iskandar S, Reddy M, Afzal MR, Rajasingh J, Atoui M, Lavu M, Atkins D, Bommana S, Umbarger L, Jaeger M, Pimentel R, Dendi R, Emert M, Turagam M, Di Biase L, Natale A, Lakkireddy D. Use of Oral Steroid and its Effects on Atrial Fibrillation Recurrence and Inflammatory Cytokines Post Ablation - The Steroid AF Study. J Atr Fibrillation 2017; 9:1604. [PMID: 29250282 DOI: 10.4022/jafib.1604] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 12/26/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022]
Abstract
Background Use of corticosteroids before and after atrial fibrillation (AF) ablation can decrease acute inflammation and reduce AF recurrence. Purpose To assess the efficacy of oral prednisone in improving the outcomes of pulmonary vein isolation with radiofrequency ablation and its effect on inflammatory cytokine. Methods A total of 60 patients with paroxysmal AF undergoing radiofrequency ablation were randomized (1:1) to receive either 3 doses of 60 mg daily of oral prednisone or a placebo. Inflammatory cytokine levels (TNF-α, IL-1, IL6, IL-8) were measured at baseline, prior to ablation, immediately after ablation, and 24 hours post ablation. Patients underwent 30 day event monitoring at 3 months, 6 months and 12 months post procedure. Results Immediate post ablation levels of inflammatory cytokines were lower in the steroid group when compared to the placebo group; IL-6: 9.0 ±7 vs 15.8 ±13 p=0.031; IL-8: 10.5 ±9 vs 15.3 ±8; p=0.047 respectively. Acute PV reconnection rates during the procedure (7/23% vs 10/36%; p = 0.39), and RF ablation time (51±13 vs 56±11 min, p = 0.11) trended to be lower in the placebo group than the steroid group. There was no difference in the incidence of early recurrence of AF during the blanking period and freedom from AF off AAD at 12 months between both groups (5/17% vs 8/27%; p = 0.347 and 21/70% vs 18/60%; p=0.417 in placebo and steroid groups respectively). Conclusion Although oral corticosteroids have significant effect in lowering certain cytokines, it did not impact the clinical outcomes of AF ablation.
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Affiliation(s)
- Sandia Iskandar
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Muhammad R Afzal
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Johnson Rajasingh
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Moustapha Atoui
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Madhav Lavu
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Sudha Bommana
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Linda Umbarger
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Misty Jaeger
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Rhea Pimentel
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Raghuveer Dendi
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Martin Emert
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Mohit Turagam
- Department of Cardiovascular Medicine, University of Missouri, Columbia, MO
| | - Luigi Di Biase
- Department of Electrophysiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
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Barajas-Martinez H, Goodrow RJ, Hu D, Patel P, Desai M, Panama BK, Treat JA, Aistrup GL, Cordeiro JM. Biophysical and molecular comparison of sodium current in cells isolated from canine atria and pulmonary vein. Pflugers Arch 2017; 469:703-712. [PMID: 28243733 DOI: 10.1007/s00424-017-1956-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 11/25/2022]
Abstract
The collar of the pulmonary vein (PV) is the focal point for the initiation of atrial arrhythmias, but the mechanisms underlying how PV cells differ from neighboring left atrial tissue are unclear. We examined the biophysical and molecular properties of INa in cells isolated from the canine pulmonary sleeve and compared the properties to left atrial tissue. PV and left atrial myocytes were isolated and patch clamp techniques were used to record INa. Action potential recordings from either tissue type were made using high-resistance electrodes. mRNA was determined using quantitative RT-PCR and proteins were determined by Western blot. Analysis of the action potential characteristics showed that PV tissue had a lower Vmax compared with left atrial tissue. Fast INa showed that current density was slightly lower in PV cells compared with LA cells (-96 ± 18.7 pA/pF vs. -120 ± 6.7 pA/pF, respectively, p < 0.05). The recovery from inactivation of INa in PV cells was slightly slower but no marked difference in steady-state inactivation was noted. Analysis of late INa during a 225-ms pulse showed that late INa was significantly smaller in PV cells compared to LA cells at all measured time points into the pulse. These results suggest PV cells have lower density of both peak and late INa. Molecular analysis of Nav1.5 and the four beta subunits showed lower levels of Nav1.5 as well as Navβ1 subunits, confirming the biophysical findings. These data show that a lower density of INa may lead to depression of excitability and predispose the PV collar to re-entrant circuits under pathophysiological conditions.
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Affiliation(s)
- Hector Barajas-Martinez
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA
| | - Robert J Goodrow
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA
| | - Dan Hu
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA
| | - Payal Patel
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA
| | - Mayurika Desai
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA
| | - Brian K Panama
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA
| | - Jacqueline A Treat
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA
| | - Gary L Aistrup
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA
| | - Jonathan M Cordeiro
- Department of Experimental Cardiology, Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, 13501, USA.
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McLellan AJ, Prabhu S, Voskoboinik A, Wong MC, Walters TE, Pathik B, Morris GM, Nisbet A, Lee G, Morton JB, Kalman JM, Kistler PM. Isolation of the posterior left atrium for patients with persistent atrial fibrillation: routine adenosine challenge for dormant posterior left atrial conduction improves long-term outcome. Europace 2017; 19:1958-1966. [DOI: 10.1093/europace/euw231] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/29/2016] [Indexed: 11/12/2022] Open
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Yokoyama K, Yamashita S, Tokutake K, Narui R, Kato M, Tanigawa S, Tokuda M, Inada K, Matsuo S, Shibayama K, Miyanaga S, Yoshimura M, Yamane T. Total absence of pulmonary vein potentials in a patient with paroxysmal atrial fibrillation: was it really isolated? Heart Vessels 2017; 32:501-505. [PMID: 28054100 DOI: 10.1007/s00380-016-0928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
We herein present a case (72 years, male) with total absence of pulmonary veins (PVs) potentials at the beginning of the first procedure for paroxysmal atrial fibrillation (AF), demonstrating dormant conduction between the left atrium and all PVs revealed by adenosine triphosphate provocation with relation to the incidence of AF. He was free from atrial arrhythmias during 1 year follow-up after complete PV isolation with the elimination of multiple transient dormant conductions by circular mapping catheter guide ablation.
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Affiliation(s)
- Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan.
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Shinichi Tanigawa
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Keiichi Inada
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Kenri Shibayama
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Satoru Miyanaga
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
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Ledderose C, Hefti MM, Chen Y, Bao Y, Seier T, Li L, Woehrle T, Zhang J, Junger WG. Adenosine arrests breast cancer cell motility by A3 receptor stimulation. Purinergic Signal 2016; 12:673-685. [PMID: 27577957 PMCID: PMC5124008 DOI: 10.1007/s11302-016-9531-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/15/2016] [Indexed: 02/06/2023] Open
Abstract
In neutrophils, adenosine triphosphate (ATP) release and autocrine purinergic signaling regulate coordinated cell motility during chemotaxis. Here, we studied whether similar mechanisms regulate the motility of breast cancer cells. While neutrophils and benign human mammary epithelial cells (HMEC) form a single leading edge, MDA-MB-231 breast cancer cells possess multiple leading edges enriched with A3 adenosine receptors. Compared to HMEC, MDA-MB-231 cells overexpress the ectonucleotidases ENPP1 and CD73, which convert extracellular ATP released by the cells to adenosine that stimulates A3 receptors and promotes cell migration with frequent directional changes. However, exogenous adenosine added to breast cancer cells or the A3 receptor agonist IB-MECA dose-dependently arrested cell motility by simultaneous stimulation of multiple leading edges, doubling cell surface areas and significantly reducing migration velocity by up to 75 %. We conclude that MDA-MB-231 cells, HMEC, and neutrophils differ in the purinergic signaling mechanisms that regulate their motility patterns and that the subcellular distribution of A3 adenosine receptors in MDA-MB-231 breast cancer cells contributes to dysfunctional cell motility. These findings imply that purinergic signaling mechanisms may be potential therapeutic targets to interfere with the motility of breast cancer cells in order to reduce the spread of cancer cells and the risk of metastasis.
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Affiliation(s)
- Carola Ledderose
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Marco M Hefti
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Yu Chen
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Yi Bao
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Thomas Seier
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Linglin Li
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Tobias Woehrle
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Jingping Zhang
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Wolfgang G Junger
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
- Ludwig Boltzmann Institute for Traumatology, Vienna, 1200, Austria.
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PRABHU SANDEEP, MACKIN VINCENT, MCLELLAN ALEXJ, PHAN TUONG, MCGLADE DESMOND, LING LIANGHAN, PECK KAHY, VOSKOBOINIK ALEXANDR, PATHIK BUPESH, NALLIAH CHRISHANJ, WONG GEOFFR, AZZOPARDI SONIAM, LEE GEOFFREY, MARIANI JUSTIN, TAYLOR ANDREWJ, KALMAN JONATHANM, KISTLER PETERM. Determining the Optimal Dose of Adenosine for Unmasking Dormant Pulmonary Vein Conduction Following Atrial Fibrillation Ablation: Electrophysiological and Hemodynamic Assessment. DORMANT-AF Study. J Cardiovasc Electrophysiol 2016; 28:13-22. [DOI: 10.1111/jce.13107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- SANDEEP PRABHU
- 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
| | | | - ALEX J.A. MCLELLAN
- 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
| | - TUONG PHAN
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | | | - LIANG-HAN LING
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - KAH Y. PECK
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
| | - ALEXANDR VOSKOBOINIK
- 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
| | - BUPESH PATHIK
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - CHRISHAN J. NALLIAH
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - GEOFF R. WONG
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - SONIA M. AZZOPARDI
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
| | - GEOFFREY LEE
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - JUSTIN MARIANI
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
| | - ANDREW J. TAYLOR
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - JONATHAN M. KALMAN
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - PETER M. KISTLER
- 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
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Teunissen C, Clappers N, Kassenberg W, Hassink RJ, van der Heijden JF, Loh P. Time matters: adenosine testing immediately after pulmonary vein isolation does not substitute a waiting period. Europace 2016; 19:1140-1145. [DOI: 10.1093/europace/euw173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/15/2016] [Indexed: 11/12/2022] Open
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Durability of cryothermal pulmonary vein isolation — Creating contiguous lesions is necessary for persistent isolation. Int J Cardiol 2016; 220:395-9. [DOI: 10.1016/j.ijcard.2016.06.211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/25/2016] [Indexed: 11/22/2022]
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EFREMIDIS MICHAEL, LETSAS KONSTANTINOSP, LIONI LOUIZA, VLACHOS KONSTANTINOS, GEORGOPOULOS STAMATIS, SAPLAOURAS ATHANASIOS, GELADARI ELENI, GIANNOPOULOS GEORGE, LIU TONG, DEFTEREOS SPYRIDON, SIDERIS ANTONIOS. Adenosine-Guided Pulmonary Vein Antral Isolation for Paroxysmal Atrial Fibrillation: A Randomized Study. J Cardiovasc Electrophysiol 2016; 27:1288-1292. [DOI: 10.1111/jce.13059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
Affiliation(s)
- MICHAEL EFREMIDIS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - KONSTANTINOS P. LETSAS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - LOUIZA LIONI
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - KONSTANTINOS VLACHOS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - STAMATIS GEORGOPOULOS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - ATHANASIOS SAPLAOURAS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - ELENI GELADARI
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - GEORGE GIANNOPOULOS
- Second Department of Cardiology; National and Kapodistrian University of Athens Medical School; Athens Greece
| | - TONG LIU
- Department of Cardiology, Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; People's Republic of China
| | - SPYRIDON DEFTEREOS
- Second Department of Cardiology; National and Kapodistrian University of Athens Medical School; Athens Greece
| | - ANTONIOS SIDERIS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
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Tokuda M, Matsuo S, Isogai R, Uno G, Tokutake K, Yokoyama K, Kato M, Narui R, Tanigawa S, Yamashita S, Inada K, Yoshimura M, Yamane T. Adenosine testing during cryoballoon ablation and radiofrequency ablation of atrial fibrillation: A propensity score-matched analysis. Heart Rhythm 2016; 13:2128-2134. [PMID: 27520540 DOI: 10.1016/j.hrthm.2016.08.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The infusion of adenosine triphosphate after radiofrequency (RF) pulmonary vein (PV) isolation (PVI), which may result in acute transient PV-atrium reconnection, can unmask dormant conduction. OBJECTIVE The purpose of this study was to compare the incidence and characteristics of dormant conduction after cryoballoon (CB) and RF ablation of atrial fibrillation (AF). METHODS Of 414 consecutive patients undergoing initial catheter ablation of paroxysmal AF, 246 (59%) propensity score-matched patients (123 CB-PVI and 123 RF-PVI) were included. RESULTS Dormant conduction was less frequently observed in patients who underwent CB-PVI than in those who underwent RF-PVI (4.5% vs 12.8% of all PVs; P < .0001). The incidence of dormant conduction in each PV was lower in patients who underwent CB-PVI than in those who underwent RF-PVI in the left superior PV (P < .0001) and right superior PV (P = .001). The site of dormant conduction was mainly located around the bottom of both inferior PVs after CB-PVI. Multivariable analysis revealed that a longer time to the elimination of the PV potential (odds ratio 1.018; 95% confidence interval 1.001-1.036; P = .04) and the necessity of touch-up ablation (odds ratio 3.242; 95% confidence interval 2.761-7.111; P < .0001) were independently associated with the presence of dormant conduction after CB-PVI. After the elimination of dormant conduction by additional ablation, the AF-free rate was similar in patients with and without dormant conduction after both CB-PVI and RF-PVI (P = .28 and P = .73, respectively). CONCLUSION The results of the propensity score-matched analysis showed that dormant PV conduction was less frequent after CB ablation than after RF ablation and was not associated with ablation outcomes.
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Affiliation(s)
- Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryota Isogai
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Goki Uno
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinichi Tanigawa
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichi Inada
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
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Abstract
Atrial fibrillation (AF) is an extremely prevalent arrhythmia that presents a wide range of therapeutic challenges. AF usually begins in a self-terminating paroxysmal form (pAF). With time, the AF pattern often evolves to become persistent (nonterminating within 7 days). Important differences exist between pAF and persistent AF in terms of clinical features, in particular the responsiveness to antiarrhythmic drugs and ablation therapy. AF mechanisms have been extensively reviewed, but few or no Reviews focus specifically on the pathophysiology of pAF. Accordingly, in this Review, we examine the available data on the electrophysiological basis for pAF occurrence and maintenance, as well as the molecular mechanisms forming the underlying substrate. We first consider the mechanistic insights that have been obtained from clinical studies in the electrophysiology laboratory, noninvasive observations, and genetic studies. We then discuss the information about underlying molecular mechanisms that has been obtained from experimental studies on animal models and patient samples. Finally, we discuss the data available from animal models with spontaneous AF presentation, their relationship to clinical findings, and their relevance to understanding the mechanisms underlying pAF. Our analysis then turns to potential factors governing cases of progression from pAF to persistent AF and the clinical implications of the basic mechanisms we review. We conclude by identifying and discussing questions that we consider particularly important to address through future research in this area.
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Li N, Csepe TA, Hansen BJ, Sul LV, Kalyanasundaram A, Zakharkin SO, Zhao J, Guha A, Van Wagoner DR, Kilic A, Mohler PJ, Janssen PML, Biesiadecki BJ, Hummel JD, Weiss R, Fedorov VV. Adenosine-Induced Atrial Fibrillation: Localized Reentrant Drivers in Lateral Right Atria due to Heterogeneous Expression of Adenosine A1 Receptors and GIRK4 Subunits in the Human Heart. Circulation 2016; 134:486-98. [PMID: 27462069 DOI: 10.1161/circulationaha.115.021165] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adenosine provokes atrial fibrillation (AF) with a higher activation frequency in right atria (RA) versus left atria (LA) in patients, but the underlying molecular and functional substrates are unclear. We tested the hypothesis that adenosine-induced AF is driven by localized reentry in RA areas with highest expression of adenosine A1 receptor and its downstream GIRK (G protein-coupled inwardly rectifying potassium channels) channels (IK,Ado). METHODS We applied biatrial optical mapping and immunoblot mapping of various atrial regions to reveal the mechanism of adenosine-induced AF in explanted failing and nonfailing human hearts (n=37). RESULTS Optical mapping of coronary-perfused atria (n=24) revealed that adenosine perfusion (10-100 µmol/L) produced more significant shortening of action potential durations in RA (from 290±45 to 239±41 ms, 17.3±10.4%; P<0.01) than LA (from 307±24 to 286±23 ms, 6.7±6.6%; P<0.01). In 10 hearts, adenosine induced AF (317±116 s) that, when sustained (≥2 minutes), was primarily maintained by 1 to 2 localized reentrant drivers in lateral RA. Tertiapin (10-100 nmol/L), a selective GIRK channel blocker, counteracted adenosine-induced action potential duration shortening and prevented AF induction. Immunoblotting showed that the superior/middle lateral RA had significantly higher adenosine A1 receptor (2.7±1.7-fold; P<0.01) and GIRK4 (1.7±0.8-fold; P<0.05) protein expression than lateral/posterior LA. CONCLUSIONS This study revealed a 3-fold RA-to-LA adenosine A1 receptor protein expression gradient in the human heart, leading to significantly greater RA versus LA repolarization sensitivity in response to adenosine. Sustained adenosine-induced AF is maintained by reentrant drivers localized in lateral RA regions with the highest adenosine A1 receptor/GIRK4 expression. Selective atrial GIRK channel blockade may effectively treat AF during conditions with increased endogenous adenosine.
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Affiliation(s)
- Ning Li
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Thomas A Csepe
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Brian J Hansen
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Lidiya V Sul
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Anuradha Kalyanasundaram
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Stanislav O Zakharkin
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Jichao Zhao
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Avirup Guha
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - David R Van Wagoner
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Ahmet Kilic
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Peter J Mohler
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Paul M L Janssen
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Brandon J Biesiadecki
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - John D Hummel
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Raul Weiss
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.)
| | - Vadim V Fedorov
- From Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, S.O.Z., A.G., P.J.M., P.M.L.J., B.J.B., V.V.F.); Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus (N.L., T.A.C., B.J.H., L.V.S., A. Kalyanasundaram, A. Kilic, P.J.M., P.M.L.J., B.J.B., J.D.H., R.W., V.V.F.); Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.); Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus (A.G., A. Kilic, P.J.M., P.M.L.J., J.D.H., R.W.); Department of Molecular Cardiology, Cleveland Clinic, OH (D.R.V.W.); and Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus (A. Kilic, J.D.H., R.W.).
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Paylos JM, Morales A, Azcona L, Paradela M, Yagüe R, Gómez-Guijarro F, Lacal L, Clara Ferrero RN, Rodríguez O. Long-Term Evolution of Patients Treated for Paroxysmal Atrial Fibrillation with First and Second Generation Cryoballoon Catheter Ablation with a Prospective Protocol Guided by Complete Bidirectional Left Atrium-Pulmonary Veins Disconnection after Adenosine as Main Target end Point to achieved. Seven Years Follow-up of Patients with a rough estimation profile of Low ALARMEc Score. A Single Center Report. J Atr Fibrillation 2016; 8:1400. [PMID: 27909504 DOI: 10.4022/jafib.1400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/20/2016] [Accepted: 03/20/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Cryoballoon ablation (CB) has proven effective for treating patients with paroxysmal atrial fibrillation (PAF). We analyzed our seven year follow-up of patients, treated for PAF with first (CB1) and second generation (CB2), with demonstration of LA-PV disconnection with bidirectional block (BB) after adenosine (AD). METHODS Since November 2008 to May 2015, 128 patients, 97 male (58±7 years), without heart disease, highly symptomatic, refractory to antiarrhythmic drugs (AAD) were treated, and follow-up (1411 ±727 days). Left atrial size: 37±6 mm. RESULTS A total of 439 PV were successfully isolated (91.9%). Acute reconduction: 44 PV (9%): 16 after CB; 16 unmasked by AD; 12 extrapulmonary muscular connections (EMC). Main complication was phrenic nerve palsy (PNP): 9 (7 %). On follow-up, 114 patients (89%) remain asymptomatic in sinus rhythm (SR), free of medication. Fourteen patients (11%) had arrhythmia recurrence: 12 male (52±8 years). Early recurrences occurred in 9 male. Late recurrences presented 3 male at 24, 27 and 60 months, and 2 female at 7 and 40 months respectively. All recurrence patients were Redo, and remain in SR without medication during follow-up. CONCLUSIONS CB alone is very effective and safe for the definitive treatment of patients suffering PAF with 72.6% success rate, increasing up to 89.1% when this protocol is applied in a single procedure. After Redo, all population group (100%), remain in sinus rhythm, freedom of arrhythmia, without AAD, in this very long term follow-up. Checking for BB, AD protocol, and ruling out EMC allowed-us to identified 14.8% of patients with underlying substrate for potential arrhythmia recurrence. CB2 applications entail a highest risk of PNP. Patients with a rough estimated profile of low ALARMEc score (≤ 1) have an excellent long term outcome, being this series the largest follow-up described so far, for patients treated for PAF with CB.
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Affiliation(s)
- Jesus M Paylos
- Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center
| | - Aracelis Morales
- Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center
| | - Luis Azcona
- Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center
| | - Marisol Paradela
- Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center
| | - Raquel Yagüe
- Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center
| | | | - Lourdes Lacal
- Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center
| | - R N Clara Ferrero
- Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center
| | - Octavio Rodríguez
- Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center
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Niu YL, Chang SL, Lin YJ, Lo LW, Hu YF, Tuan TC, Tsai CF, Lin WS, Tsao HM, Chen SA. The Electrical Characteristics and Clinical Significance of the Effect of Adenosine on Dissociated Activity after Circumferential Venous Isolation in Patients with Atrial Fibrillation. ACTA CARDIOLOGICA SINICA 2016; 31:317-24. [PMID: 27122888 DOI: 10.6515/acs20141218a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dissociated activity can occur after circumferential thoracic vein isolation for treating atrial fibrillation (AF). However, its clinical significance and response to adenosine remain unclear. METHODS Fifty-three patients (10 women, 11 with non-paroxysmal AF, with mean age 54.4 ± 11.2 years) with slow dissociated activity after thoracic vein isolation for AF ablation were analyzed. Adenosine (12 mg) was injected intravenously into 30 patients, and the responses of the dissociated activities were recorded. RESULTS The clinical characteristics and the rate of recurrence did not differ between patients with and without dissociated activity. Dissociated activity was most frequently observed at the right superior pulmonary vein (PV) (61%), left superior PV (26%), right inferior PV (5%), left inferior PV (4%), and non-PV sites (4%). The locations of dissociated activities were associated with the AF trigger sites (p = 0.004). Adenosine injection decreased the cycle length of dissociated activity in 13 patients (group 1) and increased it in 17 patients (group 2). Dissociated activity disappeared in 7 patients (41%) (group 2) after adenosine injection. During the mean 33 ± 17 months of follow-up, group 2 patients had a lower AF recurrence rate (24%) than group 1 patients (62%) (p = 0.035). CONCLUSIONS The locations of dissociated activity were closely associated with the AF trigger sites. The responses to adenosine may predict AF recurrence in patients with dissociated activity. KEY WORDS Ablation; Atrial fibrillation; Dissociated activity.
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Affiliation(s)
- Ya-Lei Niu
- Division of Cardiology, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua
| | - Shih-Lin Chang
- Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei
| | - Yenn-Jiang Lin
- Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei
| | - Li-Wei Lo
- Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei
| | - Yu-Feng Hu
- Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine
| | - Ta-Chuan Tuan
- Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine
| | - Chin-Feng Tsai
- Department of Cardiology, Chung Shan Medical University Hospital, Taichung
| | - Wei-Shiang Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital
| | - Hsuan-Ming Tsao
- Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei; ; Division of Cardiology, Department of Internal Medicine, National Yang-Ming University Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Department of Medicine and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei
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78
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Roberts JD, Gerstenfeld EP. Concomitant Isolation of the Pulmonary Veins and Posterior Wall Using a Box Lesion Set in a Patient with Persistent Atrial Fibrillation and Variant Pulmonary Venous Anatomy. Card Electrophysiol Clin 2016; 8:145-149. [PMID: 26920183 DOI: 10.1016/j.ccep.2015.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Variant pulmonary venous anatomy is common and its pre-procedural recognition through cardiac imaging facilitates a personalized approach to ablation tailored to the individual patient. Close juxtaposition of the right and left pulmonary veins is an anatomic variation that serves as an ideal substrate for creation of a single box lesion set that concomitantly isolates the pulmonary veins and posterior wall. Isolation of the posterior wall may serve as an adjunctive ablative strategy in addition to pulmonary vein isolation that facilitates maintenance of sinus rhythm among patients with persistent atrial fibrillation.
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Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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79
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DAS MOLOY, WYNN GARETHJ, MORGAN MAUREEN, RONAYNE CHRISTINA, WAKTARE JOHANE, TODD DERICKM, HALL MARKC, SNOWDON RICHARDL, MODI SIMON, GUPTA DHIRAJ. Reablated Sites of Acute Reconnection After Pulmonary Vein Isolation Do Not Predict Sites of Late Reconnection at Repeat Electrophysiology Study. J Cardiovasc Electrophysiol 2016; 27:381-9. [DOI: 10.1111/jce.12933] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/02/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- MOLOY DAS
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - GARETH J. WYNN
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - MAUREEN MORGAN
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - CHRISTINA RONAYNE
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - JOHAN E.P. WAKTARE
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - DERICK M. TODD
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - MARK C.S. HALL
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - RICHARD L. SNOWDON
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - SIMON MODI
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - DHIRAJ GUPTA
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
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80
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The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review. Cardiol Res Pract 2016; 2016:8632509. [PMID: 26981309 PMCID: PMC4770126 DOI: 10.1155/2016/8632509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/04/2016] [Indexed: 01/19/2023] Open
Abstract
The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.
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81
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Ghanbari H, Jani R, Hussain-Amin A, Al-Assad W, Huether E, Ansari S, Jongnarangsin K, Crawford T, Latchamsetty R, Bogun F, Morady F, Oral H, Chugh A. Role of adenosine after antral pulmonary vein isolation of paroxysmal atrial fibrillation: A randomized controlled trial. Heart Rhythm 2016; 13:407-15. [DOI: 10.1016/j.hrthm.2015.10.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Indexed: 11/27/2022]
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82
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Gourraud JB, Andrade JG, Macle L, Mondésert B. Pharmacological Tests in Atrial Fibrillation Ablation. Arrhythm Electrophysiol Rev 2016; 5:170-176. [PMID: 28116081 DOI: 10.15420/aer.2016:27:2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The invasive management of atrial fibrillation (AF) has been considerably changed by the identification of major sites of AF initiation and/or maintenance within the pulmonary vein antra. Percutaneous catheter ablation of these targets has become the standard of care for sustained maintenance of sinus rhythm. Long-term failure of ablation is related to an inability to create a durable transmural lesion or to identify all of the non-pulmonary vein arrhythmia triggers. Pharmacological challenges during catheter ablation have been suggested to improve outcomes in both paroxysmal and persistent AF. Herein we review the mechanism and evidence for the use of pharmacological adjuncts during the catheter ablation of AF.
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Affiliation(s)
- Jean-Baptiste Gourraud
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Jason G Andrade
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
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83
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Heijman J, Algalarrondo V, Voigt N, Melka J, Wehrens XHT, Dobrev D, Nattel S. The value of basic research insights into atrial fibrillation mechanisms as a guide to therapeutic innovation: a critical analysis. Cardiovasc Res 2015; 109:467-79. [PMID: 26705366 DOI: 10.1093/cvr/cvv275] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/11/2015] [Indexed: 02/07/2023] Open
Abstract
Atrial fibrillation (AF) is an extremely common clinical problem associated with increased morbidity and mortality. Current antiarrhythmic options include pharmacological, ablation, and surgical therapies, and have significantly improved clinical outcomes. However, their efficacy remains suboptimal, and their use is limited by a variety of potentially serious adverse effects. There is a clear need for improved therapeutic options. Several decades of research have substantially expanded our understanding of the basic mechanisms of AF. Ectopic firing and re-entrant activity have been identified as the predominant mechanisms for arrhythmia initiation and maintenance. However, it has become clear that the clinical factors predisposing to AF and the cellular and molecular mechanisms involved are extremely complex. Moreover, all AF-promoting and maintaining mechanisms are dynamically regulated and subject to remodelling caused by both AF and cardiovascular disease. Accordingly, the initial presentation and clinical progression of AF patients are enormously heterogeneous. An understanding of arrhythmia mechanisms is widely assumed to be the basis of therapeutic innovation, but while this assumption seems self-evident, we are not aware of any papers that have critically examined the practical contributions of basic research into AF mechanisms to arrhythmia management. Here, we review recent insights into the basic mechanisms of AF, critically analyse the role of basic research insights in the development of presently used anti-AF therapeutic options and assess the potential value of contemporary experimental discoveries for future therapeutic innovation. Finally, we highlight some of the important challenges to the translation of basic science findings to clinical application.
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Affiliation(s)
- Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Vincent Algalarrondo
- Department of Medicine, Montreal Heart Institute and Université de Montréal, 5000 Belanger St. E., Montreal, Canada H1T 1C8 Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
| | - Niels Voigt
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany
| | - Jonathan Melka
- Department of Medicine, Montreal Heart Institute and Université de Montréal, 5000 Belanger St. E., Montreal, Canada H1T 1C8 Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA Department of Medicine (Cardiology), Baylor College of Medicine, Houston, TX, USA Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany
| | - Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, 5000 Belanger St. E., Montreal, Canada H1T 1C8 Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany
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84
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Huemer M, Attanasio P, Wutzler A, Parwani AS, Boldt LH, Haverkamp W. [Mapping and ablation of a mechanically blocked concealed accessory pathway under repeated adenosine bolus infusions]. Herzschrittmacherther Elektrophysiol 2015; 26:371-373. [PMID: 26264483 DOI: 10.1007/s00399-015-0395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 07/27/2015] [Indexed: 06/04/2023]
Abstract
During mapping and catheter ablation of an accessory pathway, a mechanically induced conduction block can occur. Adenosine is used to detect dormant conduction of incomplete ablation lesions. Presented in this article is the case of a patient with a left-sided accessory pathway, which was mechanically blocked during the mapping procedure and could only be successfully ablated after repeated adenosine bolus infusions, which resulted in intermittent restitution of conduction via the accessory pathway.
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Affiliation(s)
- Martin Huemer
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553, Berlin, Deutschland.
| | - Philipp Attanasio
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553, Berlin, Deutschland
| | - Alexander Wutzler
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553, Berlin, Deutschland
| | - Abdul Shokor Parwani
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553, Berlin, Deutschland
| | - Leif-Hendrik Boldt
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553, Berlin, Deutschland
| | - Wilhelm Haverkamp
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13553, Berlin, Deutschland
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85
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Kumar S, Barbhaiya CR, Balindger S, John RM, Epstein LM, Koplan BA, Tedrow UB, Stevenson WG, Michaud GF. Better Lesion Creation And Assessment During Catheter Ablation. J Atr Fibrillation 2015; 8:1189. [PMID: 27957200 DOI: 10.4022/jafib.1189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/03/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
Abstract
Permanent destruction of abnormal cardiac tissue responsible for cardiac arrhythmogenesis whilst avoiding collateral tissue injury forms the cornerstone of catheter ablation therapy. As the acceptance and performance of catheter ablation increases worldwide, limitations in current technology are becoming increasingly apparent in the treatment of complex arrhythmias such as atrial fibrillation. This review will discuss the role of new technologies aimed to improve lesion formation with the ultimate goal of improving arrhythmia-free survival of patients undergoing catheter ablation of atrial arrhythmias.
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Affiliation(s)
- Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Chirag R Barbhaiya
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Samuel Balindger
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Laurence M Epstein
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Bruce A Koplan
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
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86
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Macle L, Khairy P, Weerasooriya R, Novak P, Verma A, Willems S, Arentz T, Deisenhofer I, Veenhuyzen G, Scavée C, Jaïs P, Puererfellner H, Levesque S, Andrade JG, Rivard L, Guerra PG, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet 2015. [PMID: 26211828 DOI: 10.1016/s0140-6736(15)60026-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Catheter ablation is increasingly used to manage atrial fibrillation, but arrhythmia recurrences are common. Adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve arrhythmia-free survival. We assessed whether adenosine-guided pulmonary vein isolation could prevent arrhythmia recurrence in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation. METHODS We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled patients aged older than 18 years who had had at least three symptomatic atrial fibrillation episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned (1:1) to additional adenosine-guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction was revealed, randomly selected patients were included in a registry. Patients were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. Patients were followed up for 1 year. The primary outcome was time to symptomatic atrial tachyarrhythmia after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980. FINDINGS Adenosine unmasked dormant pulmonary vein conduction in 284 (53%) of 534 patients. 102 (69·4%) of 147 patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 58 (42·3%) of 137 patients with no further ablation, corresponding to an absolute risk reduction of 27·1% (95% CI 15·9-38·2; p<0·0001) and a hazard ratio of 0·44 (95% CI 0·31-0·64; p<0·0001). Of 115 patients without dormant pulmonary vein conduction, 64 (55·7%) remained free from symptomatic atrial tachyarrhythmia (p=0·0191 vs dormant conduction with no further ablation). Occurrences of serious adverse events were similar in each group. One death (massive stroke) was deemed probably related to ablation in a patient included in the registry. INTERPRETATION Adenosine testing to identify and target dormant pulmonary vein conduction during catheter ablation of atrial fibrillation is a safe and highly effective strategy to improve arrhythmia-free survival in patients with paroxysmal atrial fibrillation. This approach should be considered for incorporation into routine clinical practice. FUNDING Canadian Institutes of Health Research, St Jude Medical, Biosense-Webster, and M Lachapelle (Montreal Heart Institute Foundation).
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Affiliation(s)
- Laurent Macle
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Paul Khairy
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Rukshen Weerasooriya
- University of Western Australia and Hollywood Private Hospital, Perth, WA, Australia
| | - Paul Novak
- Royal Jubilee Hospital, Victoria, BC, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | | | | | | | | | | | | | - Sylvie Levesque
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jason G Andrade
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Lena Rivard
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Peter G Guerra
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marc Dubuc
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Bernard Thibault
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mario Talajic
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Denis Roy
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stanley Nattel
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
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87
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Datino T. ADVICE on adenosine to improve atrial fibrillation ablation. Lancet 2015. [PMID: 26211829 DOI: 10.1016/s0140-6736(15)60241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tomás Datino
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain.
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88
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Miyazaki S, Taniguchi H, Nakamura H, Hachiya H, Ichihara N, Araki M, Kuroi A, Takagi T, Iwasawa J, Hirao K, Iesaka Y. Adenosine Triphosphate Test After Cryothermal Pulmonary Vein Isolation: Creating Contiguous Lesions Is Essential for Eliminating Dormant Conduction. J Cardiovasc Electrophysiol 2015; 26:1069-74. [PMID: 26076357 DOI: 10.1111/jce.12726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/17/2015] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Shinsuke Miyazaki
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroshi Taniguchi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Nakamura
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Noboru Ichihara
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Makoto Araki
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Akio Kuroi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Takamitsu Takagi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Jin Iwasawa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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89
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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. J Interv Card Electrophysiol 2015; 44:171-8. [PMID: 26115748 DOI: 10.1007/s10840-015-0019-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE 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.
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90
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Kumar N, Dinh T, Phan K, Timmermans C, Philippens S, Dassen W, Vranken N, Pison L, Maessen J, Crijns HJ. Adenosine testing after second-generation cryoballoon ablation (ATSCA) study improves clinical success rate for atrial fibrillation. Europace 2015; 17:871-876. [PMID: 25972302 DOI: 10.1093/europace/euu352] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/21/2014] [Indexed: 09/12/2023] Open
Abstract
AIMS Adenosine administration after pulmonary vein (PV) isolation using radiofrequency, laser, and cryoablation can cause acute recovery of conduction to the PVs and predict atrial fibrillation (AF) recurrence. This study evaluates whether ablation of dormant potentials post-adenosine administration following second-generation cryoballoon (CB-2G) ablation may improve the success rate for AF. METHODS AND RESULTS In 45 of 90 patients after a waiting period of 30 min, a bolus 15-21 mg of adenosine was administered followed by rapid saline flush. The response was assessed for each PV using a circular octapolar catheter. If needed, further ablation using a cryoballoon and/or cryocatheter was performed until no reconduction was observed after repeat adenosine administration. The remaining 45 patients did not receive adenosine after the procedure. Acute PV isolation was achieved in 352 of 358 PVs (98.3%) of 86 of 90 patients (95.6%) using CB-2G. The adenosine group showed dormant reconduction in 5 of 45 patients (11%), 8 of 179 PVs (4.5%), including 1 left superior pulmonary vein, 3 left inferior pulmonary vein, 1 right superior pulmonary vein, and 3 right inferior pulmonary vein. The success rate for adenosine and without adenosine group was 84 and 79%, respectively, after a mean follow-up of 397 ± 47 and 349 ± 66 days, without any AF recurrence in patients in whom adenosine-induced dormant conduction was ablated. CONCLUSION Adenosine testing after second-generation cryoballoon ablation study showed that reablation of initially isolated PVs increases the clinical success rate for AF.
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Affiliation(s)
- Narendra Kumar
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
| | - Trang Dinh
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
| | - Kevin Phan
- Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Carl Timmermans
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
| | - Suzanne Philippens
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
| | - Willem Dassen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
| | - Nousjka Vranken
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
| | - Laurent Pison
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
| | - Jos Maessen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
| | - Harry J Crijns
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
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91
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Michaud GF, Kumar S. Catheter Ablation for Paroxysmal Atrial Fibrillation. JACC Clin Electrophysiol 2015; 1:136-138. [DOI: 10.1016/j.jacep.2015.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/17/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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92
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Compier MG, De Riva M, Dyrda K, Zeppenfeld K, Schalij MJ, Trines SA. Incidence and predictors of dormant conduction after cryoballoon ablation incorporating a 30-min waiting period. Europace 2015; 17:1383-90. [DOI: 10.1093/europace/euu411] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/30/2014] [Indexed: 11/13/2022] Open
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93
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TAKAHASHI KEIKO, OKUMURA YASUO, WATANABE ICHIRO, NAGASHIMA KOICHI, SONODA KAZUMASA, SASAKI NAOKO, KOGAWA RIKITAKE, ISO KAZUKI, OHKUBO KIMIE, NAKAI TOSHIKO, HIRAYAMA ATSUSHI. Relation Between Left Atrial Wall Thickness in Patients with Atrial Fibrillation and Intracardiac Electrogram Characteristics and ATP-Provoked Dormant Pulmonary Vein Conduction. J Cardiovasc Electrophysiol 2015; 26:597-605. [DOI: 10.1111/jce.12660] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/12/2015] [Accepted: 02/20/2015] [Indexed: 11/30/2022]
Affiliation(s)
- KEIKO TAKAHASHI
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - YASUO OKUMURA
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - ICHIRO WATANABE
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - KOICHI NAGASHIMA
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - KAZUMASA SONODA
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - NAOKO SASAKI
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - RIKITAKE KOGAWA
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - KAZUKI ISO
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - KIMIE OHKUBO
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - TOSHIKO NAKAI
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
| | - ATSUSHI HIRAYAMA
- Division of Cardiology, Department of Medicine; Nihon University School of Medicine; Tokyo Japan
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94
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Kuroi A, Miyazaki S, Usui E, Ichihara N, Kanaji Y, Takagi T, Iwasawa J, Nakamura H, Taniguchi H, Hachiya H, Iesaka Y. Adenosine-Provoked Atrial Fibrillation Originating From Non-Pulmonary Vein Foci: The Clinical Significance and Outcome After Catheter Ablation. JACC Clin Electrophysiol 2015; 1:127-135. [PMID: 29759355 DOI: 10.1016/j.jacep.2015.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/23/2015] [Accepted: 02/26/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The goal of this study was to systematically investigate the incidence and clinical significance of non-pulmonary vein (PV) foci revealed by adenosine/adenosine triphosphate (ATP) testing during atrial fibrillation (AF) ablation. BACKGROUND ATP is reported to provoke AF. METHODS A total of 464 patients with consecutive paroxysmal AF undergoing ATP testing after PV antrum isolation were included. RESULTS AF originating from non-PV foci was provoked in 26 (5.6%) total patients during first (n = 20) or repeat (n = 8) ablation procedures. Dormant PV conduction was also revealed by ATP testing in 6 patients. Non-PV foci were located in the superior vena cava (SVC) (i.e., the SVC group) and atria (i.e., the atria group) in 10 and 18 (9 each in the right and left atria) patients, respectively. In the multivariable analysis, being female was the sole independent predictor of ATP-provoked AF originating from non-PV foci (hazard ratio [HR]: 2.52 [95% confidence interval (CI): 1.069 to 5.929]; p = 0.034). After additional ablation targeting non-PV foci, freedom from recurrent AF after the last procedure was similar between the SVC group and patients without ATP-provoked AF but was significantly lower in the atria group than in others (p = 0.0008). Atria group membership (HR: 3.725 [95% CI: 1.692 to 8.199]; p = 0.001) and being female (HR: 1.538 [95% CI: 1.189 to 1.989]; p = 0.001) were significant independent predictors associated with recurrence after the last procedure in the multivariable Cox regression model. CONCLUSIONS ATP provoked AF originating from non-PV foci under isoproterenol in 5.6% of patients undergoing paroxysmal AF ablation. ATP testing might be useful for identifying and eliminating AF originating from the SVC. The atria group was associated with a poor outcome after the last procedure despite efforts to eliminate non-PV foci.
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Affiliation(s)
- Akio Kuroi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Shinsuke Miyazaki
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
| | - Eisuke Usui
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Noboru Ichihara
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Takamitsu Takagi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Jin Iwasawa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Nakamura
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroshi Taniguchi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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95
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Kimura T, Takatsuki S, Miyoshi S, Takahashi M, Ogawa E, Nakajima K, Kashimura S, Katsumata Y, Nishiyama T, Nishiyama N, Tanimoto Y, Aizawa Y, Arai T, Fukuda K. Electrical superior vena cava isolation using photodynamic therapy in a canine model. Europace 2015; 18:294-300. [DOI: 10.1093/europace/euv016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/22/2015] [Indexed: 11/13/2022] Open
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96
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Üçer E, Fredersdorf S, Jungbauer CG, Seegers J, Debl K, Riegger G, Maier LS. Unmasking the dormant pulmonary vein conduction with adenosine administration after pulmonary vein isolation with laser energy. Europace 2015; 17:1376-82. [PMID: 25759410 DOI: 10.1093/europace/euu368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/01/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS The isolation of the pulmonary veins (PVs) is the mainstay of atrial fibrillation (AF) ablation, which with current ablation techniques can be achieved in almost all cases. Reconnection of PVs constitutes the most frequent cause of AF recurrence. Visually guided laser balloon ablation (VGLA) is a novel system with very high rate of persistence of pulmonary vein isolation (PVI) three months after the first procedure shown in preclinical and clinical studies. We aimed to determine the acute efficiency of the laser energy during PVI with the help of adenosine provocation. METHODS AND RESULTS Twenty-six patients (19 male; mean age 64 ± 9 years) with symptomatic paroxysmal AF were included in the study. Pulmonary vein isolation was performed using the VGLA system. After successful PVI, we studied the effects of intravenous adenosine (18 mg) on activation of each PV at least 20 min after PVI. A total of 104 PVs were targeted. The balloon catheter could not be placed in two PVs. Of the remaining 102 PVs 99 (97% of the ablated PVs) could be successfully isolated. Adenosine was administered for each isolated PV in 25 patients. Only six PVs (6.7%) in five patients (20%) showed a PV reconnection during adenosine provocation. CONCLUSION Pulmonary vein isolation with VGLA is a feasible technique for PVI with a very effective acute lesion formation. The clinical significance of this low reconnection rate has to be determined.
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Affiliation(s)
- Ekrem Üçer
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Sabine Fredersdorf
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Carsten Gerald Jungbauer
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Joachim Seegers
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Kurt Debl
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Günter Riegger
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Lars Siegfried Maier
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
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97
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LIN FRANKS, IP JAMESE, MARKOWITZ STEVENM, LIU CHRISTOPHERF, THOMAS GEORGE, LERMAN BRUCEB, CHEUNG JIMW. Limitations of Dormant Conduction as a Predictor of Atrial Fibrillation Recurrence and Pulmonary Vein Reconnection after Catheter Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:598-607. [DOI: 10.1111/pace.12596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/06/2015] [Accepted: 01/14/2015] [Indexed: 01/10/2023]
Affiliation(s)
- FRANK S. LIN
- Division of Cardiology, Department of Medicine; Weill Cornell Medical College; New York New York
| | - JAMES E. IP
- Division of Cardiology, Department of Medicine; Weill Cornell Medical College; New York New York
| | - STEVEN M. MARKOWITZ
- Division of Cardiology, Department of Medicine; Weill Cornell Medical College; New York New York
| | - CHRISTOPHER F. LIU
- Division of Cardiology, Department of Medicine; Weill Cornell Medical College; New York New York
| | - GEORGE THOMAS
- Division of Cardiology, Department of Medicine; Weill Cornell Medical College; New York New York
| | - BRUCE B. LERMAN
- Division of Cardiology, Department of Medicine; Weill Cornell Medical College; New York New York
| | - JIM W. CHEUNG
- Division of Cardiology, Department of Medicine; Weill Cornell Medical College; New York New York
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98
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Spotnitz MD, Markowitz SM, Liu CF, Thomas G, Ip JE, Liez J, Lerman BB, Cheung JW. Mechanisms and clinical significance of adenosine-induced dormant accessory pathway conduction after catheter ablation. Circ Arrhythm Electrophysiol 2014; 7:1136-43. [PMID: 25378468 DOI: 10.1161/circep.114.002140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adenosine can unmask dormant pulmonary vein conduction after isolation. The role of adenosine in uncovering dormant accessory pathway (AP) conduction after AP ablation is unknown. METHODS AND RESULTS We evaluated 109 consecutive patients (age, 41 ± 28 years; 62 [57%] men) who were administered adenosine after successful AP ablation. Dormant AP conduction was defined as adenosine-induced recurrent AP conduction, as demonstrated by recurrent preexcitation or change in retrograde ventriculoatrial activation patterns. Dormant AP conduction was identified in 13 (12%) patients. Adenosine led to transient retrograde AP conduction in 6 patients and transient anterograde AP conduction in 8 patients. In all these cases, adenosine-induced AP conduction occurred during the bradycardia phase of adenosine effect and resulted in dormant AP conduction times shorter than atrioventricular nodal conduction times before adenosine administration. On the basis of analysis of timing of occurrence of dormant AP conduction, the mechanism of adenosine-induced AP conduction was determined to be caused by AP excitability recovery in ≥ 12 (92%) cases. The presence of dormant AP conduction was a significant predictor of chronic recurrent AP conduction requiring repeat ablation (odds ratio, 8.54; 95% confidence interval, 1.09-66.9; P=0.041). CONCLUSIONS Adenosine can unmask dormant AP conduction after catheter ablation. Direct effects of adenosine on the AP, possibly via AP membrane potential hyperpolarization, are the dominant mechanism of adenosine-induced AP conduction after ablation. Dormant AP conduction is associated with higher rates of recurrent AP conduction requiring repeat ablation.
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Affiliation(s)
- Michelle D Spotnitz
- From the Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Steven M Markowitz
- From the Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Christopher F Liu
- From the Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - George Thomas
- From the Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - James E Ip
- From the Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Joshua Liez
- From the Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Bruce B Lerman
- From the Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Jim W Cheung
- From the Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY.
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99
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Weerasooriya R, Shah AJ, Hocini M, Jaïs P, Haïssaguerre M. Contemporary Challenges of Catheter Ablation for Atrial Fibrillation. Clin Ther 2014; 36:1145-50. [DOI: 10.1016/j.clinthera.2014.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/08/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
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100
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Nishida K, Datino T, Macle L, Nattel S. Atrial Fibrillation Ablation. J Am Coll Cardiol 2014; 64:823-31. [DOI: 10.1016/j.jacc.2014.06.1172] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/26/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
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