Role of adenosine after antral pulmonary vein isolation of paroxysmal atrial fibrillation: A randomized controlled trial

Ghanbari, Hamid; Jani, Ronak H.; Hussain-Amin, Atheer; Al-Assad, Wassim; Huether, Elizabeth; Ansari, Sardar; Jongnarangsin, Krit; Crawford, Thomas; Latchamsetty, Rakesh; Bogun, Frank; Morady, Fred; Oral, Hakan; Chugh, Aman

doi:10.1016/j.hrthm.2015.10.016

Cited by 37 publications

(60 citation statements)

References 17 publications

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“…132 Adenosineguided pulmonary vein isolation has been recommended, after a randomized clinical trial, for the treatment of paroxysmal AF, 133 but this has been questioned in a more recent clinical trial. 134 The clinical significance of ATP-induced AF has been investigated. 135 The presence of AF does not affect the efficacy of the P2Y 12 antagonists prasugrel and ticagrelor.…”

Section: Heart Diseasesmentioning

confidence: 99%

Purinergic Signaling in the Cardiovascular System

Burnstock

2017

Circulation Research

339

295

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Abstract:There is nervous control of the heart by ATP as a cotransmitter in sympathetic, parasympathetic, and sensory-motor nerves, as well as in intracardiac neurons. Centers in the brain control heart activities and vagal cardiovascular reflexes involve purines. Adenine nucleotides and nucleosides act on purinoceptors on cardiomyocytes, AV and SA nodes, cardiac fibroblasts, and coronary blood vessels. Vascular tone is controlled by a dual mechanism. ATP, released from perivascular sympathetic nerves, causes vasoconstriction largely via P2X1 receptors. Endothelial cells release ATP in response to changes in blood flow (via shear stress) or hypoxia, to act on P2 receptors on endothelial cells to produce nitric oxide, endothelium-derived hyperpolarizing factor, or prostaglandins to cause vasodilation. ATP is also released from sensory-motor nerves during antidromic reflex activity, to produce relaxation of some blood vessels. Purinergic signaling is involved in the physiology of erythrocytes, platelets, and leukocytes. ATP is released from erythrocytes and platelets, and purinoceptors and ectonucleotidases are expressed by these cells. P1, P2Y 1 , P2Y 12 , and P2X1 receptors are expressed on platelets, which mediate platelet aggregation and shape change. Long-term (trophic) actions of purine and pyrimidine nucleosides and nucleotides promote migration and proliferation of vascular smooth muscle and endothelial cells via P1 and P2Y receptors during angiogenesis, vessel remodeling during restenosis after angioplasty and atherosclerosis. The involvement of purinergic signaling in cardiovascular pathophysiology and its therapeutic potential are discussed, including heart failure, infarction, arrhythmias, syncope, cardiomyopathy, angina, heart transplantation and coronary bypass grafts, coronary artery disease, diabetic cardiomyopathy, hypertension, ischemia, thrombosis, diabetes mellitus, and migraine. (Circ Res. 2017;120:207-228.

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Section: Heart Diseasesmentioning

confidence: 99%

Purinergic Signaling in the Cardiovascular System

Burnstock

2017

Circulation Research

339

295

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“…While this is turn allowed examination of a total of 480 WACA segments examined, the prevalence of acute segment reconnection was relatively low, which limits the strength of the observations. Additionally, no further waiting period was applied after reisolation of acutely reconnected sites, and this may have limited the yield of acute reconnection sites as it has previously been shown that further sites become apparent with more prolonged waiting periods . While clinical outcome data are included, analysis relating to these was precluded by reablation at sites of late reconnection at repeat electrophysiology study, which is the main intervention in the randomized controlled trial from which this study population was derived.…”

Section: Limitationsmentioning

confidence: 99%

Reablated Sites of Acute Reconnection After Pulmonary Vein Isolation Do Not Predict Sites of Late Reconnection at Repeat Electrophysiology Study

Das

Wynn

Morgan

et al. 2016

Cardiovasc electrophysiol

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“…The recently published results of this trial showed that this strategy unmasked dormant PV conduction in 21% of the tested PVs and that additional adenosine-guided ablation did improve arrhythmia-free survival (69.4 vs. 42.3%) [16]. However, these results could not be confirmed in two also recently published trials in which no significant reduction of recurrence in the adenosine-guided ablation group could be found [17, 18]. …”

Section: Discussionmentioning

confidence: 98%

Adenosine administration during hybrid atrial fibrillation ablation to test dormant pulmonary vein conduction

Vroomen

Meir

Crijns

et al. 2017

J Interv Card Electrophysiol

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BackgroundAdenosine administration after initial pulmonary vein isolation (PVI) reveals dormant conduction and predicts atrial fibrillation (AF) recurrence. Elimination of dormant conduction when present may increase a long-term success rate of AF ablation procedures. There are no studies till date using adenosine to reveal acute reconduction of pulmonary veins (PVs) after epicardial PVI during a hybrid AF ablation procedure.MethodsWe included 24 patients (21 male, 55 ± 9 years) undergoing hybrid ablation for symptomatic paroxysmal (n = 12) and persistent (n = 12) AF, using an epicardial bipolar radiofrequency clamp to perform PVI. All antiarrhythmic medications were discontinued 5 days prior to the procedure, except for patients on amiodarone. Thirty minutes after PVI and once sinus rhythm was obtained, a bolus of adenosine (12 to 36 mg) was administered intravenously. The subsequent response was assessed for each PV (n = 96) using an in situ circular mapping catheter.ResultsDormant conduction (i.e., the reappearance of PV potentials during at least one beat) was seen in 1 out of 96 PVs (1%). If reconduction was seen, further endocardial ablation using a 3.5-mm irrigated tip catheter was performed until no more reconduction occurred after repeating the adenosine bolus.ConclusionsAdenosine administration after PVI with the use of an epicardial bipolar radiofrequency clamp in the setting of hybrid AF ablation reveals acute reconduction in 1% of the PVs.

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Role of adenosine after antral pulmonary vein isolation of paroxysmal atrial fibrillation: A randomized controlled trial

Cited by 37 publications

References 17 publications

Purinergic Signaling in the Cardiovascular System

Purinergic Signaling in the Cardiovascular System

Reablated Sites of Acute Reconnection After Pulmonary Vein Isolation Do Not Predict Sites of Late Reconnection at Repeat Electrophysiology Study

Adenosine administration during hybrid atrial fibrillation ablation to test dormant pulmonary vein conduction

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