Adenosine plasma level in patients with paroxysmal or persistent atrial fibrillation and normal heart during ablation procedure and/or cardioversion
- 38 Downloads
The mechanism of atrial fibrillation (AF) in patients with normal heart remains unclear. While exogenous adenosine can trigger AF, nothing is known about the behavior of endogenous adenosine plasma level (APL) at the onset of AF and during ablation procedure. Ninety-one patients (68 with paroxysmal AF: 40 males, 66 ± 16 years; 23 with persistent AF: 14 males, 69 ± 11 years) and 18 controls were included. Among paroxysmal patients: i) medical therapy alone was performed in 45 cases and ablation procedure in 23. AF was spontaneously resolutive in 6 cases; ii) 23 underwent ablation procedure and blood was collected simultaneously in a brachial vein and in the left atrium; 17 were spontaneously in sinus rhythm while 6 were in sinus rhythm after direct current cardioversion. Among persistent patients: i) in 17 patients, blood samples were collected in a brachial vein before and after direct current cardioversion; ii) in 6 patients, blood samples were collected simultaneously in a brachial vein and in left atrium before and after cardioversion during ablation procedure. CV-APL was higher in patients with persistent AF vs patients with paroxysmal AF (median [range]: 0.9[0.6–1.1] vs 0.7[0.4–1.1] μM; p < 0.001). In patients with paroxysmal AF, LA-APL increased during the AF episode (0.95[0.85–1.4] vs 2.7[1.5–7] μM; p = 0.03) and normalized in sinus rhythm after DCCV. In patients with persistent AF, LA-APL was higher than CV-APL (1.2[0.7–1.8] vs 0.9[0.6–1.1] μM; p < 0.001), and both normalized in sinus rhythm (CV-APL: 0.8[0.6–1.1] vs 0.75[0.4–1] μM; p = 0.03), (LA-APL: 1.95[1.3–3] vs 1[0.5–1.15] μM; p = 0.03). The occurrence of AF is associated with a strong increase of APL in the atrium. The cause of this increase needs further investigations.
KeywordsAdenosine Atrial fibrillation Ablation procedure
BM, FF, and JCD: patient inclusion, study design, and writing the paper.
GM, RG, PM, AB, and RG: study design and writing the manuscript.
MM, DV, PD, MC, PM, and CG: critical review of the paper.
EM, PM, MG, and LK: patients selection and participating in study design.
MG, PM, and MC: biological analysis and statistical analysis.
EF, JR, and JLG: critical review of the paper.
Aix Marseille University and assistance Publique des Hopitaix de Marseille.
Compliance with ethical standards
Conflict of interest
Baptiste Maille declares that he/she has no conflict of interest.
Marion Marlinge declares that he/she has no conflict of interest.
Donato Vairo declares that he/she has no conflict of interest.
Giovanna Mottola declares that he/she has no conflict of interest.
Linda Koutbi declares that he/she has no conflict of interest.
Pierre Deharo declares that he/she has no conflict of interest.
Marguerite Gastaldi declares that he/she has no conflict of interest.
Marine Gaudry declares that he/she has no conflict of interest.
Claire Guiol declares that he/she has no conflict of interest.
Sara Bottone declares that he/she has no conflict of interest.
Patrick Mace declares that he/she has no conflict of interest.
Rosita Gueant declares that he/she has no conflict of interest.
Mohamed Chefrour declares that he/she has no conflict of interest.
Elsa Martinez declares that he/she has no conflict of interest.
Pierre Michelet declares that he/she has no conflict of interest.
Jean Louis Gueant declares that he/she has no conflict of interest.
Alain Boussuges declares that he/she has no conflict of interest.
Jean Ruf declares that he/she has no conflict of interest.
Emmanuel Fenouillet declares that he/she has no conflict of interest.
Jean Claude Deharo declares that he/she has no conflict of interest.
Régis Guieu declares that he/she has no conflict of interest.
Frederic Franceschi declares that he/she has no conflict of interest.
This study complies with the declaration of Helsinki. The study was approved by the ethical committee of the Timone University hospital. Written informed consents were obtained from all the participants.
- 6.Iqbal M, Jena A, Park HS, Baek YS, Lee KN, Roh SY, Shi JM, Choi JJ, Kim YH (2017) Value of adenosine test to reveal dormant conduction or adenosine-induced atrial fibrillation after pulmonary vein isolation. J Arrhythm 33:602–607. https://doi.org/10.1016/j.joa.2017.07.015 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Datino T, Macle L, Qi XY, Maguy A, Comtois P, Chartier D, Guerra PG, Arenal A, Fernandez-Aviles F, Nattel S (2010) Mechanisms by which adenosine restores conduction in dormant canine pulmonary veins. Circulation 121:963–972. https://doi.org/10.1161/CIRCULATIONAHA.109.893107 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Cheung JW, Ip JE, Chung JH, Markowitz SM, Liu CF, Thomas G, Lee JM, Lessner SJ, Lerman BB (2012) Differential effects of adenosine on pulmonary vein ectopy after pulmonary vein isolation: implications for arrhythmogenesis. Circ Arrhythm Electrophysiol 5:659–666. https://doi.org/10.1161/CIRCEP.112.971945 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P (2016) ESC scientific document group. ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18:1609–1616CrossRefPubMedCentralGoogle Scholar
- 10.MarlingeN M, Vairo D, Marolda V, Bruzzese L, Adjriou N, Guiol C, Kipson N, Bonnardel A, Gastaldi M, Kerbaul F, Michelet P, Deharo JC, Mottola G, Mace P, Chefrour M, Guieu R (2017) Rapid measurement of adenosine in human blood using fixed potential amperometry: comparison with mass spectrometry and HPLC. J Anal Bioanal Tech 8:1000371–1000374. https://doi.org/10.4172/2155-9872.10003 CrossRefGoogle Scholar
- 11.Nee L, Franceschi F, Resseguier N, Gravier G, Giorgi R, Gariboldi V, Collart F, Michelet P, Deharo JC, Guieu R, Kerbaul F (2013) High endogenous adenosine plasma concentration is associated with atrial fibrillation during cardiac surgery with cardiopulmonary bypass. Int J Cardiol 165:201–204. https://doi.org/10.1016/j.ijcard.2012.08.018 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Atienza F, Almendral J, Moreno J, Vaidyanathan R, Talkachou A, Kalifa J, Arenal A, Villacastin JP, Torrecilla EG, Sanchez A, Ploutz-Snyder R, Jalife J, Brenfeld O (2006) Activation of inward rectifier potassium channels accelerates atrial fibrillation in humans: evidence for a reentrant mechanism. Circulation 114:2334–2342CrossRefGoogle Scholar
- 15.Li N, Csepe TA, Hansen BJ, Sul LV, Kalyanasundaram A, Zakharkin SO, Zhao J, Guha A, Wagoner DR, Kilic A, Janssen PM, Biesiadecki BJ, Weiss JD, Fedorov VV (2016) 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 134:486–498. https://doi.org/10.1161/CIRCULATIONAHA.115.021165 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Llach A, Molina CE, Prat-Vidal C, Fernandes J, Casadó V, Ciruela F, Lluis C, Franco R, Cinca J, Hove-Madsen L (2011) Abnormal calcium handling in atrial fibrillation is linked to up-regulation of adenosine A2A receptors. Eur Heart J 32:721–729. https://doi.org/10.1093/eurheartj/ehq464 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Morillo CA, Banerjee A, Perel P, Wood D, Jouven X (2017) Atrial fibrillation: the current epidemic. J Geriatr Cardiol 14:195–203. https://doi.org/10.11909/j.issn.1671-5411.2017.03.011 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Casiglia E, Tikhonoff V, Albertini F, Gasparotti F, Mazza A, Montagnana M, Danese E, Benati M, Spinella P, Palatini P (2018) Caffeine intake reduces incident atrial fibrillation at a population level. Eur J Prev Cardiol 25:1055–1062. https://doi.org/10.1177/2047487318772945 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Yegutkin GG (2008) Nucleotide and nucleoside-converting ectoenzymes: important modulators of purinergic signaling cascade. Biochim Biophys Acta 1783:673–694Google Scholar
- 24.Lecka J, Rana MS, Sévigny J (2010) Inhibition of vascular ectonucleotidase activities by the pro-drugs ticlopidine and clopidogrel favours platelet aggregation. Br J Pharmacol 161:1150–1160Google Scholar
- 25.Bonello L, Laine M, Kipson N, Mancini J, Helal O, Fromonot J, Gariboldi V, Condo J, Thuny F, Frere C, Camoin-Jau L, Paganelli F, Dignat-George F, Guieu R (2014) Ticagrelor increases adenosine plasma concentration in patients with an acute coronary syndrome. J Am Coll Cardiol 63:872–877. https://doi.org/10.1016/j.jacc.2013.09.067 CrossRefPubMedPubMedCentralGoogle Scholar
- 26.de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ, van den Heijkant AC, Allessie MA, Crijns HJ (2010) Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol 55:725–731. https://doi.org/10.1016/j.jacc.2009.11.040 CrossRefPubMedPubMedCentralGoogle Scholar