Early detection of pulmonary vein reconnection after isolation in patients with paroxysmal atrial fibrillation: a comparison of ATP-induction and reassessment at 30 minutes postisolation.

Abstract:

INTRODUCTION:Catheter ablation for paroxysmal AF (PAF) is limited by an unacceptable recurrence rate, mainly due to pulmonary vein (PV) reconnection. Strategies to minimize reconnection include adenosine infusion and also a waiting period of 30 minutes after PV isolation. The aim of the present study was to assess whether these two strategies revealed the same conduction gap. METHODS AND RESULTS:In total, 88 consecutive patients (54 males, mean age of 60 years) with drug refractory PAF underwent circumferential PV isolation (CPVI). After isolation of ipsilateral PVs, with entry and exit block checked using a circular mapping catheter, 20 mg ATP was injected during isoproterenol infusion to reveal dormant conduction gap(s). Unless the reconnection revealed by ATP persisted, PVs were further remapped with the circular mapping catheter at 30 minutes postisolation. Totally, PV reconnection was observed in 56 (64%) patients. 24.3% veins (80/329) were found reconnected. Reassessment at 30 minutes postablation was more efficient as compared to ATP induction (19.8% vs 14.6% for ATP). The agreement between these 2 methods is moderate (kappa value = 0.50). In veins that transiently reconnected after ATP administration and later observed at 30 minutes postablation, 94% (17 of 19) of them were found being reconnected with the same gap. CONCLUSION:Acute PV reconnection is common, occurring in 64% of patients, as detected by adenosine infusion and waiting time. Each shows a unique quality as compared to one another. The combined use of these 2 methods may reduce the AF recurrence rate after CPVI.

authors

Jiang CY,Jiang RH,Matsuo S,Liu Q,Fan YQ,Zhang ZW,Fu GS

doi

10.1111/j.1540-8167.2009.01564.x

subject

Has Abstract

pub_date

2009-12-01 00:00:00

pages

1382-7

issue

12

eissn

1045-3873

issn

1540-8167

pii

JCE1564

journal_volume

20

pub_type

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