Characteristics of dormant pulmonary vein conduction induced by adenosine triphosphate in patients with atrial fibrillation undergoing cryoballoon ablation

• Published in: Journal of cardiology 2018-06, Vol.71 (6), p.577-582
• Main Authors: Okishige, Kaoru, Aoyagi, Hideshi, Nishimura, Takurou, Shigeta, Takatoshi, Nakamura, Tomofumi, Yamauchi, Yasuteru, Keida, Takehiko, Sasano, Tetsuo, Hirao, Kenzo
• Format: Article
• Language: English
• Subjects: Adenosine; Adenosine Triphosphate - pharmacology; Aged; Atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Catheter Ablation; Cryoballoon ablation; Dormant conduction; Female; Humans; Male; Middle Aged; Prognosis; Pulmonary Veins - drug effects; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Recurrence; Treatment Outcome
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2017.11.008

•Dormant conductions after cryoballoon ablation are relatively rare.•Durability of electrical isolation of pulmonary veins by cryoballoon is good.•No predictor existed of dormant conduction. Adenosine triphosphate (ATP) can provoke acute reconnections after pulmonary vein isolation (PVI). This study aimed to investigate dormant conduction (DC) after ablation with second-generation cryoballoon (CB). Two hundred sixteen patients (148 male; age 64±9 years) with atrial fibrillation (AF) were included. After a successful PVI with the CB, 20mg of ATP was administered. All patients were followed up for 425±56 days. Seven hundred ninety-five out of 864 (92%) PVs were successfully isolated solely by the CB. DCs were revealed in 8 (3.7%) after ATP injections. AF recurrences occurred in 2 out of 8 patients, while no AF recurrences could be documented in 6 out of 8 patients with DCs after a blanking period of 3 months (25% vs. 75%). In contrast, 29 (13.9%) patients without DCs had AF recurrences, and there was no significant difference between those with and without DCs regarding the recurrence rate of AF (p=0.38). There were no reliable predictors of DCs after the PVI with the CB. The present study demonstrated a low rate of transient PV reconnection after adenosine infusion following successful PVI with the CB. There was no reliable predictor of DCs. Further studies will be needed in order to appreciate the prognostic value of adenosine testing after successful PVI with the CB.