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The Role of Adenosine in Pulmonary Vein Isolation: a Critical Review


Affiliations
1 Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 Barcelona, Spain
2 Electrophysiology Department, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX39DU, United Kingdom
 

The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk.The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.
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  • The Role of Adenosine in Pulmonary Vein Isolation: a Critical Review

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Authors

Paolo D. Dallaglio
Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 Barcelona, Spain
Timothy R. Betts
Electrophysiology Department, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX39DU, United Kingdom
Matthew Ginks
Electrophysiology Department, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX39DU, United Kingdom
Yaver Bashir
Electrophysiology Department, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX39DU, United Kingdom
Ignasi Anguera
Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, 08907 Barcelona, Spain
Kim Rajappan
Electrophysiology Department, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX39DU, United Kingdom

Abstract


The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk.The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.