Document Detail

Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination (ADVICE): Methods and Rationale.
MedLine Citation:
PMID:  22217936     Owner:  NLM     Status:  Publisher    
BACKGROUND: Pulmonary vein (PV) isolation (PVI) has emerged as an effective therapy for paroxysmal atrial fibrillation (AF). However, AF recurs in up to 50% of patients, generally because of recovery of PV conduction. Adenosine given during the initial procedure may reveal dormant PV conduction, thereby identifying the need for additional ablation, leading to improved outcomes. The Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination (ADVICE) study is a prospective multicentre randomized trial assessing the impact of adenosine-guided PVI in preventing AF recurrences. METHODS: Patients undergoing a first PVI procedure for paroxysmal AF will be recruited. After standard PVI is completed, all patients will receive intravenous adenosine in an attempt to unmask dormant conduction. If dormant conduction is elicited, patients will be randomized to no further ablation (control group) or additional adenosine-guided ablation until dormant conduction is abolished. If no dormant conduction is revealed, randomly selected patients will be followed in a registry. The primary outcome is time to first documented symptomatic AF recurrence. Assuming that dormant conduction is present in 50% of patients post PVI and symptomatic AF recurs in 45% of controls, 244 patients with dormant conduction will be required to obtain > 90% power to detect a difference of 20%. Thus, a total of 488 patients will be enrolled and followed for 12 months. CONCLUSION: The ADVICE trial will assess whether a PVI strategy incorporating elimination of dormant conduction unmasked by intravenous adenosine will decrease the rate of recurrent symptomatic AF compared with standard PVI.
Laurent Macle; Paul Khairy; Atul Verma; Rukshen Weerasooriya; Stephan Willems; Thomas Arentz; Paul Novak; George Veenhuyzen; Christophe Scavée; Allan Skanes; Helmut Puererfellner; Pierre Jaïs; Yaariv Khaykin; Lena Rivard; Peter G Guerra; Marc Dubuc; Bernard Thibault; Mario Talajic; Denis Roy; Stanley Nattel;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-2
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  -     ISSN:  1916-7075     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Montreal Heart Institute and Montreal Heart Institute Coordinating Centre, Université de Montréal, Montréal, Québec, Canada.
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