Τίτλος:
Adenosine-Guided Pulmonary Vein Antral Isolation for Paroxysmal Atrial Fibrillation: A Randomized Study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Efremidis, M.
Letsas, K.P.
Lioni, L.
Vlachos, K.
Georgopoulos, S.
Saplaouras, A.
Geladari, E.
Giannopoulos, G.
Liu, T.
Deftereos, S.
Sideris, A.
Περιοδικό:
Journal of Cardiovascular Electrophysiology
Εκδότης:
Blackwell Publishing Inc.
Λέξεις-κλειδιά:
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
