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Adenosine testing after second-generation balloon devices (cryothermal and laser) mediated pulmonary vein ablation for atrial fibrillation

  • Narendra Kumar
  • Yuri Blaauw
  • Carl Timmermans
  • Laurent Pison
  • Kevin Vernooy
  • Harry Crijns
Article

Abstract

Aims

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.

Methods

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.

Results

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 %).

Conclusion

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.

Keywords

Atrial fibrillation Catheter ablation Cryoballoon Endoscopic balloon Laser Adenosine Pulmonary vein isolation 

Notes

Acknowledgments

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.

Funding

None.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Narendra Kumar
    • 1
  • Yuri Blaauw
    • 1
  • Carl Timmermans
    • 1
  • Laurent Pison
    • 1
  • Kevin Vernooy
    • 1
  • Harry Crijns
    • 1
  1. 1.Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands

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