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Adenosine facilitates dormant conduction across cavo-tricuspid isthmus following catheter ablation.
MedLine Citation:
PMID:  22789426     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: Recurrence of trans-isthmus conduction following catheter ablation of common right atrial flutter (AFL) has been reported to be as high as 15-31% at 3 months with invasive follow-up. Intravenous adenosine has previously been shown to facilitate acute, transient reconnection of pulmonary veins following catheter ablation of atrial fibrillation. We sought to determine if intravenous adenosine can facilitate dormant trans-isthmus conduction after achieving bidirectional conduction block with catheter ablation. METHODS: Thirty-two patients underwent radiofrequency catheter ablation of cavo-tricuspid isthmus (CTI) for common right atrial flutter at two institutions. Once persistent bidirectional conduction block (BDB) was achieved for 30 minutes and during isoproterenol infusion, 18 mg of IV adenosine was injected during coronary sinus pacing. Evidence for transient re-conduction across the isthmus was observed. Additional ablation lesions were performed and adenosine infusion was repeated to reassess for dormant conduction. RESULTS: Thirty-two (Male 81%, HTN 72%, CAD 15%, CHF 25%, DM 30%, LA size 42 ± 11 mm, LVEF 51 ± 10 %) patients underwent ablation of CTI. Bidirectional conduction block (BDB) was achieved in 30 of 32 patients. Following adenosine infusion, transient re-conduction was observed in 7 of 30 (23%) patients, for 10-45 seconds. Following additional ablation lesions, persistent BDB could be achieved in all 7 patients without evidence for re-conduction with repeat adenosine infusion. During a mean follow-up of 19 ± 12 months, only one (3%) of the 30 patients had clinical recurrence of atrial flutter. None of the patients with transient re-conduction after adenosine developed symptomatic recurrence of atrial flutter. CONCLUSIONS: Adenosine infusion can facilitate dormant conduction across CTI following catheter ablation. Persistent BDB can be achieved with additional ablation. Adenosine challenge with additional ablation may improve long-term clinical outcome.
Authors:
Pugazhendhi Vijayaraman; Gopi Dandamudi; Angela Naperkowski; Jess Oren; Randle Storm; Kenneth A Ellenbogen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-9
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
Cardiac Electrophysiology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA.
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