Adenosine testing after second-generation balloon devices (cryothermal and laser) mediated pulmonary vein ablation for atrial fibrillation
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Adenosine administration after pulmonary vein (PV) isolation using radiofrequency and cryoablation can cause acute recovery of conduction to the PVs and predicts atrial fibrillation (AF) recurrence. This study evaluated whether adenosine testing after second-generation balloon devices (cryothermal and laser) could reveal dormant PV reconduction and recurrence rate of AF.
Out of total 60 patients, 20 patients underwent PV isolation using laser balloon and for the remaining patients, the cryoballoon was used. Following PVI, waiting period of 30 min was obtained. Thereafter, a bolus 15–21 mg of adenosine was injected followed by rapid saline flush. The subsequent response was assessed for each vein using an in situ lasso catheter. Further ablation (if needed) using laser balloon and cryocatheter respectively was done, until no reconduction occurred after repeat adenosine.
Acute PV isolation was achieved in all 80 PVs of 20 patients (100 %) using laser device and in 151 PVs (96.2 %) of 38 patients (95 %) using cryoballoon. However, in seven patients (35 %), 11 PVs (13.7 %) (4 LSPV, 2 LIPV, 4 RSPV, and 1 RIPV) showed dormant PV potentials after adenosine administration in laser group. Cryoballoon group showed dormant reconduction in four patients (10 %), four PVs (5 %) [one LSPV, one LIPV, and two RIPV]. The follow-up of 337 ± 92.4 days for cryoballoon and 267 ± 76.9 days for laser balloon group demonstrated similar success rates (85 %).
Adenosine testing after PV isolation using second-generation balloon based energy devices (laser and cryothermal) reveals dormant conduction in initially isolated PVs with similar long-term success rate.
KeywordsAtrial fibrillation Catheter ablation Cryoballoon Endoscopic balloon Laser Adenosine Pulmonary vein isolation
We would like to thank Suzanne Philippens (RN) for helping us in retrieving clinical follow-up data, Nousjka Vranken (BASc), and Willem Daessen, PhD for statistical analysis.
- 3.Cappato, R., Negroni, S., Pecora, D., Bentivegna, S., Lupo, P. P., Carolei, A., et al. (2003). Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation, 108(13), 1599–1604.PubMedCrossRefGoogle Scholar
- 4.Ouyang, F., Antz, M., Ernst, S., Hachiya, H., Mavrakis, H., Deger, F. T., et al. (2005). Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation, 111(2), 127–135.PubMedCrossRefGoogle Scholar
- 7.Metzner, A., Schmidt, B., Fuernkranz, A., Wissner, E., Tilz, R. R., Chun, K. R., et al. (2011). One-year clinical outcome after pulmonary vein isolation using the novel endoscopic ablation system in patients with paroxysmal atrial fibrillation. Heart Rhythm, 8(7), 988–993.PubMedCrossRefGoogle Scholar
- 8.Dukkipati, S. R., Kuck, K. H., Neuzil, P., Woollett, I., Kautzner, J., McElderry, H. T., et al. (2013). Pulmonary vein isolation using a visually guided laser balloon catheter: the first 200-patient multicenter clinical experience. Circulation Arrhythmia and Electrophysiology, 6(3), 467–472.PubMedCrossRefGoogle Scholar
- 9.Dukkipati, S. R., Neuzil, P., Kautzner, J., Petru, J., Wichterle, D., Skoda, J., et al. (2012). The durability of pulmonary vein isolation using the visually guided laser balloon catheter: multicenter results of pulmonary vein remapping studies. Heart Rhythm, 9(6), 919–925.PubMedCrossRefGoogle Scholar
- 10.Metzner, A., Wissner, E., Schmidt, B., Chun, J., Hindricks, G., Piorkowski, C., et al. (2013). Acute and long-term clinical outcome after endoscopic pulmonary vein isolation: results from the first prospective, multicenter study. Journal of Cardiovascular Electrophysiology, 24(1), 7–13.PubMedCrossRefGoogle Scholar
- 13.Hachiya, H., Hirao, K., Takahashi, A., Nagata, Y., Suzuki, K., Maeda, S., et al. (2007). Clinical implications of reconnection between the left atrium and isolated pulmonary veins provoked by adenosine triphosphate after extensive encircling pulmonary vein isolation. Journal of Cardiovascular Electrophysiology, 18(4), 392–398.PubMedCrossRefGoogle Scholar
- 18.Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Journal of Interventional Cardiac Electrophysiology, 33(2), 171–257.PubMedCrossRefGoogle Scholar
- 22.Schmidt, B., Gunawardene, M., Krieg, D., Bordignon, S., Furnkranz, A., Kulikoglu, M., et al. (2013). A prospective randomized single-center study on the risk of asymptomatic cerebral lesions comparing irrigated radiofrequency current ablation with the cryoballoon and the laser balloon. Journal of Cardiovascular Electrophysiology, 24(8), 869–874.PubMedCrossRefGoogle Scholar
- 25.Cheung, J. W., Chung, J. H., Ip, J. E., Markowitz, S. M., Liu, C. F., Thomas, G., et al. (2012). Time course of adenosine-induced pulmonary vein reconnection after isolation: implications for mechanism of dormant conduction. Pacing and Clinical Electrophysiology, 35(5), 556–563.PubMedCrossRefGoogle Scholar