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Determining the Optimal Dose of Adenosine for Unmasking Dormant Pulmonary Vein Conduction Following Atrial Fibrillation Ablation: Electrophysiological and Hemodynamic Assessment. DORMANT-AF Study.
- Source :
- Journal of Cardiovascular Electrophysiology; Jan2017, Vol. 28 Issue 1, p13-22, 10p, 1 Diagram, 5 Charts, 3 Graphs
- Publication Year :
- 2017
-
Abstract
- Introduction: The significance of adenosine induced dormant pulmonary vein (PV) conduction in atrial fibrillation (AF) ablation remains controversial. The optimal dose of adenosine to determine dormant PV conduction is yet to be systematically explored. Methods and Results: Consecutive patients undergoing index AF ablation received 3 adenosine doses (12, 18, and 24 mg) in a randomized blinded order, immediately after pulmonary vein isolation (PVI). Electrophysiological (PR prolongation, AV block (AVB) and PV reconnection) and hemodynamic (BP) parameters were measured. A total, 339 doses (113/dose) assessed 191 PVs in 50 patients (66% male, 72% PAF, 52% hypertensive). Dormant PV conduction occurred in 28% of patients (16.5% [32] of PVs). All cases were associated with AVB (AVB: PV reconnection vs. no PV reconnection 100% vs. 83%, P = 0.007). AVB occurred more frequently at 24 mg versus 12 mg (92% vs. 82%, P = 0.019) but not versus 18 mg (91%, P = 0.62). AVB duration progressed between 12 mg (12.0 ± 8.9 seconds), 18 mg (16.1 ± 9.1 seconds, P = 0.001), and 24 mg (19.0 ± 9.3 seconds, P < 0.001) doses. MBP fell further at 24 mg (-MBP: 27 ± 12 mmHg) and 18 mg (26 ± 13 mmHg) doses compared to 12 mg (22 ± 10 mmHg vs., P < 0.001). A significant reduction in AVB in patients >110 kg (65% vs. 91% in 70-110 kg group, P < 0.001) in response to adenosine was seen. Conclusion: An adenosine dose producing AVB is required to unmask dormant PV conduction. AVB is significantly reduced in patients >110 kg. Weight and dosing variability may in part explain the conflicting results of studies evaluating the clinical utility of adenosine in PVI. [ABSTRACT FROM AUTHOR]
- Subjects :
- ATRIAL fibrillation treatment
ADENOSINES
ATRIOVENTRICULAR node
BLOOD pressure measurement
BODY weight
CATHETER ablation
CHI-squared test
CLINICAL trials
STATISTICAL correlation
ELECTROPHYSIOLOGY
HEMODYNAMICS
MEDICAL cooperation
PULMONARY veins
RESEARCH
RESEARCH funding
STATISTICAL sampling
STATISTICAL hypothesis testing
T-test (Statistics)
PATIENT selection
DESCRIPTIVE statistics
Subjects
Details
- Language :
- English
- ISSN :
- 10453873
- Volume :
- 28
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Journal of Cardiovascular Electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 120788846
- Full Text :
- https://doi.org/10.1111/jce.13107