Residual conduction after pulmonary vein isolation with a circular multielectrode radiofrequency ablation catheter: The role of adenosine and orciprenalin during a prolonged observation time

Brunelli, Michele; Raffa, Santi; Große, A.; Hanazawa, Koji; Sammut, Mark; Roos, Markus; Frommhold, Markus; Wauters, Kristel; Geller, J. Christoph

doi:10.1016/j.ijcard.2013.07.071

Cited by 10 publications

(5 citation statements)

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“…In our study, as well as in a study by Brunelli et al. [ 20 ], the highest rate of reconnection was observed for the inferior quadrant of the right lower PV, most likely due to difficulties in appropriately engaging this vein with the PVAC and early branching of this vein [ 21 ]. Optimal electrode-tissue contact with all electrode pairs may be more difficult to achieve due to the circular design of the catheter.…”

Section: Discussionsupporting

confidence: 70%

“…In order to reduce PV reconnections, longer waiting periods and additional pharmacological testing, e. g. using adenosine, revealing ‘dormant’ PV conduction, have been proposed [ 20 ]. When isolation was assessed 30 minutes after electrical disconnection using an irrigated catheter, up to 33 % of the PVs recovered conduction, and reconnection rates further increased at 60 minutes to a maximum of 50 % in up to 93 % of the patients [ 13 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Spatial distribution of electrical reconnection after pulmonary vein isolation in patients with recurrent paroxysmal atrial fibrillation

et al. 2016

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IntroductionRecurrence of atrial fibrillation after pulmonary vein isolation (PVI) occurs frequently and may be associated with electrical reconnection of the pulmonary veins (PV). We investigated spatial distribution of electrical reconnection during re-do procedures in patients with paroxysmal atrial fibrillation who had previous successful acute electrical PVI with either single irrigated tip, antral ablation (s-RF; n = 38) or multi-electrode, duty-cycled ablation (PVAC; n = 48).Methods and ResultsEP navigator, mapping and irrigated tip ablation catheters were used in all re-do procedures. Sites of reconnection were assessed in a 12-segment model. Baseline clinical and demographic characteristics were similar in both groups. The number of PVs reconnected per patient was similar in both groups (2.9 ± 0.9 and 3.2 ± 0.7 (p = 0.193), s‑RF and PVAC, respectively), and each PV was equally affected. However, the inferior quadrant of the right lower PV was significantly more vulnerable to reconnection after previous PVAC ablation, whereas the superior quadrant of the right upper PV showed significantly more reconnection in the s‑RF group.ConclusionThe overall number of PVs reconnected was equally high in both groups, and each PV was affected equally. However, there were significant differences in the spatial distribution of electrical reconnection. Better understanding of predilection sites for reconnection might help to improve the long-term success rate of PVI.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Spatial distribution of electrical reconnection after pulmonary vein isolation in patients with recurrent paroxysmal atrial fibrillation

et al. 2016

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“…Dosing regimens in trials evaluating adenosine mediated dormant conduction, including the 2 largest randomized trials, have varied considerably . However, the potential impact of adenosine dosing upon the clinical outcomes has not been explored.…”

Section: Discussionmentioning

confidence: 99%

“…Dosing regimens in trials evaluating adenosine mediated dormant conduction, including the 2 largest randomized trials, have varied considerably. [15][16][17][18] However, the potential impact of adenosine dosing upon the clinical outcomes has not been explored. Macle et al performed a multicenter randomized controlled trial involving 534 patients with paroxysmal AF with dormant conduction present in 284 (53%).…”

Section: Discussionmentioning

confidence: 99%

Determining the Optimal Dose of Adenosine for Unmasking Dormant Pulmonary Vein Conduction Following Atrial Fibrillation Ablation: Electrophysiological and Hemodynamic Assessment. DORMANT‐AF Study

Prabhu

Mackin

McLellan

et al. 2016

Cardiovasc electrophysiol

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“…Therefore, the pathophysiological impact of our findings with the view to AF recurrences correlated with PV reconnections patterns and time of AF recurrence is limited. As there was no adenosine challenge during PV mapping, concealed reconnection might remain undetected in some cases which could have affected the presented PV reconnection patterns and the resulting correlation with AF recurrences over time [20].…”

Section: Study Limitationsmentioning

confidence: 99%

Is the Time of Atrial Fibrillation Recurrence After Duty-Cycled Radiofrequency Ablation Affected by the Pattern of Pulmonary Vein Reconnections?

2020

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Background: Pulmonary vein isolation (PVI) with multielectrode duty-cycled radiofrequency (PVAC) has been shown to be effective in the treatment of atrial fibrillation (AF). We describe pulmonary vein (PV) reconnection at repeat ablation in patients with AF recurrence after PVAC PVI and analyze the correlation between the time of AF recurrence and the observed PV reconnection patterns. Methods: Eighty-five patients undergoing a redo PVI for recurrent AF 9.2 ± 3.8 months after an initial PVAC PVI procedure was retrospectively enrolled. Results: A total of 93% had PV reconnections with a mean of 2.97 ± 1.2 reconnected PVs/patients and 75% of formerly isolated PVs were found reconnected. The highest reconnection rates (94%) were observed for left common trunks (CTs). A total of 33% patients had three and four reconnected PVs, respectively, while 7% were without PV reconnection. There was a moderate but significant negative correlation between the time of AF recurrences and the extending of PV reconnections at redo PVI for patients with proven PV reconnection (r =-0.32, P = 0.005), whereas five out of six patients without PV reconnection had recurrences within the first 9 months after PVI. Conclusions: At redo ablation most patients with recurrence of AF after PVAC PVI had PV reconnection(s). Patients with PV reconnection(s) showed a moderate negative correlation between the number of reconnected PVs and the time of AF recurrence with more extensive PV reconnections resulting in earlier PV recurrences after the blanking period. Patients without PV reconnection experienced early AF recurrences, indicating non-PV triggers contribute to AF recurrences in these patients.

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Residual conduction after pulmonary vein isolation with a circular multielectrode radiofrequency ablation catheter: The role of adenosine and orciprenalin during a prolonged observation time

Cited by 10 publications

References 46 publications

Spatial distribution of electrical reconnection after pulmonary vein isolation in patients with recurrent paroxysmal atrial fibrillation

Spatial distribution of electrical reconnection after pulmonary vein isolation in patients with recurrent paroxysmal atrial fibrillation

Determining the Optimal Dose of Adenosine for Unmasking Dormant Pulmonary Vein Conduction Following Atrial Fibrillation Ablation: Electrophysiological and Hemodynamic Assessment. DORMANT‐AF Study

Is the Time of Atrial Fibrillation Recurrence After Duty-Cycled Radiofrequency Ablation Affected by the Pattern of Pulmonary Vein Reconnections?

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