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Prevalence and clinical impact of spontaneous and adenosine-induced pulmonary vein reconduction in the Contact-Force vs. Cryoballoon Atrial Fibrillation Ablation (CIRCA-DOSE) study
- Source :
- Heart Rhythm. 17:897-904
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Use of intraprocedural observation and pharmacologic challenges have been proposed as means to differentiate permanent pulmonary vein (PV)-left atrial conduction block from inadequate ablation lesions.The purpose of this study was to determine the prevalence and clinical impact of spontaneous and adenosine-provoked reconnection using contemporary atrial fibrillation (AF) ablation technologies.The CIRCA-DOSE (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation: Double Short vs. Standard Exposure Duration) study enrolled 346 patients with paroxysmal AF and randomized them to contact force-guided radiofrequency ablation (CF-RF) or cryoballoon ablation. Patients underwent provocative testing with adenosine after a 20-minute observation period. All patients received an implantable cardiac monitor for arrhythmia monitoring.Spontaneous reconnection was observed in 5.4% of PVs (71/1318) during the 20-minute postprocedure observation period, and dormant conduction was elicited in 5.7% of PVs (75/1318). Both spontaneous reconnection and dormant conduction were more common after CF-RF compared to cryoballoon ablation (P = .03 and P.0001, respectively). Acute PV reconnection (spontaneous or adenosine-provoked) was associated with a significantly higher incidence of recurrent atrial tachyarrhythmia in the cryoballoon group (hazard ratio [HR] 2.39; 95% confidence interval [CI] 1.44-3.96; P = .0007) but not in the CF-RF group (HR 1.47; 95% CI 0.84-2.58; P = .16). In the absence of acute reconnection, the freedom from recurrent arrhythmia did not differ between groups (HR 0.95; 95% CI 0.6057-1.495; P = .83).Patients without spontaneous or adenosine-provoked reconnection had better outcomes compared to those with acute PV reconnection, suggesting that efforts should be directed toward ensuring an ideal ablation lesion at the first attempt in order to achieve durable PV isolation.
- Subjects :
- Male
medicine.medical_specialty
Adenosine
Radiofrequency ablation
Vasodilator Agents
medicine.medical_treatment
Vascular Remodeling
030204 cardiovascular system & hematology
Cryosurgery
Pulmonary vein
law.invention
Lesion
03 medical and health sciences
0302 clinical medicine
Heart Conduction System
law
Physiology (medical)
Internal medicine
Atrial Fibrillation
Prevalence
medicine
Dormant conduction
Humans
Single-Blind Method
Prospective Studies
030212 general & internal medicine
Implantable cardiac monitor
business.industry
Atrial fibrillation
Middle Aged
Ablation
medicine.disease
Pulmonary Veins
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
medicine.drug
Subjects
Details
- ISSN :
- 15475271
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- Heart Rhythm
- Accession number :
- edsair.doi.dedup.....fe90067fb2ea7286e868b8287505055d