Document Detail

"Dormant" pulmonary vein conduction revealed by adenosine after ostial radiofrequency catheter ablation.
MedLine Citation:
PMID:  15363077     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The endogenous nucleoside adenosine is an important intermediate in cellular metabolism, a regulator of function in many organ systems, and a pharmacologic agent with potent electrophysiologic effects. We studied the effects of adenosine on the activation of the pulmonary veins (PVs) after successful ostial isolation in patients with atrial fibrillation (AF). METHODS AND RESULTS: Twenty-nine patients (21 male; mean age 54 +/- 10 years) with refractory highly symptomatic persistent (n = 9) or paroxysmal (n = 20) AF were included in the study. PV isolation was performed using radiofrequency catheter ablation guided by a multipolar basket catheter (Constellation, Boston Scientific). After successful PV isolation, we studied the effects of intravenous adenosine (12-18 mg) on activation of the upper PVs. A total of 83 PVs were successfully isolated. After adenosine, PV activity was recorded in 10 (34%) of 29 left upper PVs studied and in 3 (13%) of 24 right upper PVs, coupled to atrial activity for 20 +/- 7 seconds (adenosine positive). In 8 (62%) of 13 cases, PV potentials were recorded in the distal electrodes of the basket catheter only. Dissociated PV rhythms (N = 8) present after PV isolation disappeared after adenosine for 18 +/- 7 seconds, even if reconduction was missing. In 14 patients (48%), a second EP study was performed for recurrence of AF. Adenosine-positive PVs had a nonsignificant higher rate of recovery of conduction than adenosine-negative veins (71% vs 35%, P = 0.095). CONCLUSION: Adenosine induces transient conduction in 25% of PVs following successful isolation. Further studies are necessary to determine the physiologic or pathophysiologic role of adenosine-induced reconduction in human hearts or other organ systems.
Thomas Arentz; Laurent Macle; Dietrich Kalusche; Mélèze Hocini; Pierre Jais; Dipen Shah; Michel Haissaguerre
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  15     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-14     Completed Date:  2005-02-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1041-7     Citation Subset:  IM    
Rhythmologie, Herz-Zentrum, Bad Krozingen, Germany.
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MeSH Terms
Adenosine / pharmacology*,  therapeutic use
Anti-Arrhythmia Agents / pharmacology*,  therapeutic use
Atrial Fibrillation / drug therapy*,  surgery
Catheter Ablation*
Drug Resistance
Heart Conduction System / drug effects*
Middle Aged
Prospective Studies
Pulmonary Veins / drug effects*,  surgery
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 58-61-7/Adenosine
Comment In:
J Cardiovasc Electrophysiol. 2004 Sep;15(9):1048-9   [PMID:  15363078 ]

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