Loss of Pace Capture on the Ablation Line During Pulmonary Vein Isolation versus "Dormant Conduction": Is Adenosine Expendable?
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Loss of Pace Capture on the Ablation Line During Pulmonary Vein Isolation versus "Dormant Conduction": Is Adenosine Expendable? / Schaeffer, Benjamin; Willems, Stephan; Sultan, Arian; Hoffmann, Boris A; Lüker, Jakob; Schreiber, Doreen; Akbulak, Ruken; Moser, Julia; Kuklik, Pawel; Steven, Daniel.
in: J CARDIOVASC ELECTR, Jahrgang 26, Nr. 10, 10.2015, S. 1075-1080.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Loss of Pace Capture on the Ablation Line During Pulmonary Vein Isolation versus "Dormant Conduction": Is Adenosine Expendable?
AU - Schaeffer, Benjamin
AU - Willems, Stephan
AU - Sultan, Arian
AU - Hoffmann, Boris A
AU - Lüker, Jakob
AU - Schreiber, Doreen
AU - Akbulak, Ruken
AU - Moser, Julia
AU - Kuklik, Pawel
AU - Steven, Daniel
N1 - © 2015 Wiley Periodicals, Inc.
PY - 2015/10
Y1 - 2015/10
N2 - INTRODUCTION: Permanent pulmonary vein isolation (PVI) remains an essential goal of ablation therapy in patients with atrial fibrillation. Aim of this study was the intraindividual comparison of unexcitability to pacing along the ablation line versus dormant conduction (DC) as additional procedural endpoints.METHODS: A total of 58 patients with paroxysmal atrial fibrillation (PAF) underwent PVI by circumferential ablation of ipsilateral pulmonary veins (PVs), followed by testing for DC by adenosine administration. Irrespective of the presence of DC, pacing along the ablation line for left atrium capture was performed and additional radio frequency energy applied if necessary. PVs with initial DC were retested after achieving unexcitability.RESULTS: PVI was achieved in 224 of 224 PVs. In 33 of 224 PVs (15%) DC was revealed. At 92 of 112 ablation lines (82%) sites of excitability were found. Three (9%) of the initial 33 PVs with DC showed further DC after achieving unexcitability at repeated testing. Thirty-two of 33 assumed areas of unmasked PV-LA reconduction as revealed by DC-testing showed a corresponding site of excitability on the ablation line. After a follow-up of 11.6 ± 3.4 months 79% of patients were free of arrhythmia.CONCLUSIONS: Pacing for unexcitability can safely identify potential sites of DC and even sites that would have not been detected by testing for DC. Unexcitability, therefore, serves as a suitable and safe procedural endpoint not only for patients with contraindications to adenosine administration. Our data suggest that adenosine may be expendable when achieving unexcitability along the ablation line.
AB - INTRODUCTION: Permanent pulmonary vein isolation (PVI) remains an essential goal of ablation therapy in patients with atrial fibrillation. Aim of this study was the intraindividual comparison of unexcitability to pacing along the ablation line versus dormant conduction (DC) as additional procedural endpoints.METHODS: A total of 58 patients with paroxysmal atrial fibrillation (PAF) underwent PVI by circumferential ablation of ipsilateral pulmonary veins (PVs), followed by testing for DC by adenosine administration. Irrespective of the presence of DC, pacing along the ablation line for left atrium capture was performed and additional radio frequency energy applied if necessary. PVs with initial DC were retested after achieving unexcitability.RESULTS: PVI was achieved in 224 of 224 PVs. In 33 of 224 PVs (15%) DC was revealed. At 92 of 112 ablation lines (82%) sites of excitability were found. Three (9%) of the initial 33 PVs with DC showed further DC after achieving unexcitability at repeated testing. Thirty-two of 33 assumed areas of unmasked PV-LA reconduction as revealed by DC-testing showed a corresponding site of excitability on the ablation line. After a follow-up of 11.6 ± 3.4 months 79% of patients were free of arrhythmia.CONCLUSIONS: Pacing for unexcitability can safely identify potential sites of DC and even sites that would have not been detected by testing for DC. Unexcitability, therefore, serves as a suitable and safe procedural endpoint not only for patients with contraindications to adenosine administration. Our data suggest that adenosine may be expendable when achieving unexcitability along the ablation line.
KW - Adenosine
KW - Atrial Fibrillation/diagnosis
KW - Catheter Ablation/methods
KW - Electrocardiography/drug effects
KW - Female
KW - Heart Conduction System/drug effects
KW - Humans
KW - Male
KW - Middle Aged
KW - Monitoring, Intraoperative/methods
KW - Pulmonary Veins/drug effects
KW - Recurrence
KW - Treatment Outcome
U2 - 10.1111/jce.12759
DO - 10.1111/jce.12759
M3 - SCORING: Journal article
C2 - 26183341
VL - 26
SP - 1075
EP - 1080
JO - J CARDIOVASC ELECTR
JF - J CARDIOVASC ELECTR
SN - 1045-3873
IS - 10
ER -