TY - JOUR
TI - Adenosine-Guided Pulmonary Vein Antral Isolation for Paroxysmal Atrial Fibrillation: A Randomized Study
AU - Efremidis, M.
AU - Letsas, K.P.
AU - Lioni, L.
AU - Vlachos, K.
AU - Georgopoulos, S.
AU - Saplaouras, A.
AU - Geladari, E.
AU - Giannopoulos, G.
AU - Liu, T.
AU - Deftereos, S.
AU - Sideris, A.
JO - Journal of Cardiovascular Electrophysiology
PY - 2016
VL - 27
TODO - 11
SP - 1288-1292
PB - Blackwell Publishing Inc.
SN - 1045-3873, 1540-8167
TODO - 10.1111/jce.13059
TODO - adenosine, adult;  Article;  catheter ablation;  controlled study;  female;  follow up;  heart arrhythmia;  heart ejection fraction;  heart left ventricle ejection fraction;  human;  major clinical study;  male;  outcome assessment;  paroxysmal atrial fibrillation;  priority journal;  pulmonary vein isolation;  survival rate;  transesophageal echocardiography
TODO - Objectives: The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction and whether such conduction should be eliminated still remain controversial. This randomized study aimed to investigate whether adenosine-guided ablation of the reconnection gaps improves the long-term outcomes of pulmonary vein antral isolation (PVAI) for paroxysmal atrial fibrillation (AF). Methods and Results: Consecutive patients with paroxysmal AF were randomly assigned to undergo (n = 80, group 1) or not (n = 81, group 2) adenosine testing following PVAI. Adenosine-mediated PV dormant conduction was unmasked in 26 patients (32.5%) of group 1. Successful elimination of the reconnection gaps was subsequently performed in all patients. During a mean follow-up period of 11.39 ± 5.10 months, 30 patients of group 1 (37.5%), and 27 patients of group 2 (33.3%) experienced arrhythmia recurrence. The Kaplan–Meier arrhythmia free survival curves failed to demonstrate any significant differences between study groups (log rank 0.217, P = 0.642). Fourteen of 26 (53.8%) patients with adenosine-mediated dormant conduction and subsequent elimination of reconnection gaps experienced AF recurrence during follow-up. On the contrary, only 16 of 54 patients without dormant conduction (29.6%) displayed arrhythmia recurrence (P = 0.049). Logistic regression analysis showed that adenosine-mediated PV reconnection (hazard ratio 0.292, 95% confidence interval 0.122–0.483; P = 0.01) was an independent predictor of AF recurrence. Conclusion: In this patients’ cohort, adenosine-mediated PV reconnection is predictive of future arrhythmic events. Elimination of dormant conduction with additional ablation lesions does not improve the long-term outcome of the procedure compared to the standard PVAI. © 2016 Wiley Periodicals, Inc.
ER -