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Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter
- Source :
- Journal of Cardiovascular Electrophysiology. 28:876-881
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
Abstract
- Background Dormant conduction unmasked by adenosine predicts clinical recurrences of cavotricuspid isthmus (CTI) dependent atrial flutter following catheter ablation. Conventional practice involves a waiting period of 20 to 30 minutes after achievement of a bidirectional line of block (BDB) to monitor for recovery of conduction. Objective Assess whether abolition of dormant conduction with adenosine immediately after CTI ablation and BDB can predict the lack of CTI conduction recovery during the following 30 minutes. Methods Consecutive patients undergoing catheter ablation for CTI-dependent atrial flutter were studied. Following the completion of CTI ablation and documentation of BDB, adenosine (≥12 mg IV) was administered immediately. In cases of dormant conduction, the CTI was ablated again until its abolition. After the achievement of BDB without dormant conduction, spontaneous CTI reconnection during the following 30 minutes and dormant conduction with adenosine at 30 minutes were evaluated. Results A CTI block was achieved in 171 patients. Nine patients (5.3%) had dormant conduction across the CTI immediately after ablation and BDB, and required further ablation. Two patients (1.2%) had subsequent spontaneous time-dependent reconnection within 30 minutes. Two other patients (1.2%) developed late dormant conduction with adenosine at 30 minutes. All 4 patients underwent further ablation. Conclusion A negative adenosine challenge immediately after CTI ablation with bidirectional block, or after abolition of dormant conduction with further ablation, strongly predicted the absence of subsequent spontaneous reconnection within 30 minutes. Based on these results, the conventional waiting period is unnecessary in 97.6% patients without dormant conduction after CTI-dependent flutter ablation.
- Subjects :
- medicine.medical_specialty
Cavotricuspid isthmus
Heart block
business.industry
medicine.medical_treatment
fungi
Catheter ablation
030204 cardiovascular system & hematology
medicine.disease
Ablation
Adenosine
Waiting period
03 medical and health sciences
0302 clinical medicine
Physiology (medical)
Internal medicine
medicine
Cardiology
030212 general & internal medicine
Electrical conduction system of the heart
Cardiology and Cardiovascular Medicine
business
Atrial flutter
medicine.drug
Subjects
Details
- ISSN :
- 10453873
- Volume :
- 28
- Database :
- OpenAIRE
- Journal :
- Journal of Cardiovascular Electrophysiology
- Accession number :
- edsair.doi...........524637662e9e32a3ce5b94eaeb107ea9