Abstract
Background: It is well known that additional radiofrequency (RF) applications to eliminate transient pulmonary vein (PV) reconnections induced by adenosine triphosphate (ATP) lead to a reduced recurrence of atrial fibrillation (AF) after PV isolation (PVI). However, no studies have explored the utility of ATP with a sufficient observation period. Methods: Of 322 consecutive patients (81 female; mean age 62 ± 11 years) with paroxysmal (PAF) or chronic AF (CAF) that underwent a PVI procedure, 222 had PAF, and 100 CAF. All patients received an extensive PVI procedure, and the CAF patient received an additional left atrial ablation. After the procedures, all patients underwent a right cavotricuspid isthmus ablation during the observation period and all received 20mg of ATP to assess for any dormant PV conduction. If the patients had reconnections of the PVs, additional RF energy was delivered till no reconnections were observed during the ATP injections. Results: Forty six gaps (14%) were observed after the observation period, but 69 transient gaps (21%) were recorded during the ATP injections. All transient PV reconnection gaps were abolished by additional RF applications. During a mean follow-up period of 12 ± 5 months, recurrences of AF were observed in 43 patients (26 in PAF patients, 17 in CAF patients). In patients with recurrent AF (group-R), the observation period was significantly shorter than on those without recurrent AF (group-S) (group-R vs. group-S = 17 ± 12 vs. 26 ± 17 min, P < 0.01, PAF patients: 18 ± 14 vs. 26 ± 17 min, P < 0.05, CAF patients: 17 ± 9 vs. 25 ± 15 min, P < 0.05, respectively). There were no significant differences in the left atrial diameter (group-R vs. group-S = 37 ± 6 vs. 39 ± 8 mm, P = NS) between group-R and group-S. Further, there were no significant differences in the other parameters between the two groups. Conclusion: The results of this study demonstrate that remapping more than 25 minutes after the PVI was efficient for finding recurrence gaps, similar to with ATP injections. A sufficient observation period and the use of ATP may be useful methods to reduce AF recurrences after PVI in both PAF and CAF patients.
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