Abstract
BackgroundAdenosine can be used to reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI). This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation Long-Term registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety.MethodsThe registry consists of 104 participating centers in 27 countries within the European Society of Cardiology. The registry data was split into an adenosine group (AG) and no-adenosine group (NAG). Procedure characteristics and patient outcome were compared.ResultsAdenosine was administered in 10.8% of the 3591 PVI patients included in the registry. Spain, the Netherlands, and Italy included the majority of adenosine cases (48.8%). Adenosine was applied more often in combination with open irrigation radiofrequency (RF) energy (74.7%) and less often in combination with nonirrigated RF energy (1.6%). After 1 year, a higher percentage of the AG was free from AF compared with the NAG (68.9% vs 59.1%, p < 0.001). Adenosine was associated with better rhythm outcome in RF ablation procedures, but not in cryo-ablation procedures (freedom from AF: RF: AG: 70.9%, NAG: 58.1%, p < 0.001, cryo: AG: 63.9%, NAG: 63.8%, p = 0.991).ConclusionsThe use of adenosine was associated with a better rhythm outcome after 1 year follow-up and seems more useful in patients treated with RF energy compared with patients treated with cryo energy. Given the improved rhythm outcome at 1-year follow-up, it seems reasonable to encourage the use of adenosine during RF AF ablation.
Highlights
Ablation of the pulmonary veins (PVs) or atrium ideally results in irreversible cell damage and subsequent cell death, but can temporarily cause reversible cell damage leading to a lower resting potential
This study presents a subanalysis of the large ESC EURObservational Research Programme (EORP) Atrial Fibrillation Ablation (AFA) Long-Term registry consisting of real-world 1-year follow-up data to analyze the effects of adenosine use during PV isolation (PVI) treatment in terms of rhythm outcome and safety
Out of all patients enrolled in the registry, patients with an unclassified type of AF, patients who did not undergo an ablation procedure, or patients treated with both radiofrequency (RF) and cryo energy in the same procedure were excluded to be able to perform the analyses presented in this paper
Summary
Ablation of the pulmonary veins (PVs) or atrium ideally results in irreversible cell damage and subsequent cell death, but can temporarily cause reversible cell damage leading to a lower resting potential. These nondestroyed cells are more difficult to activate, causing a transient electrical block [1]. Once the resting potential of the nondestroyed cells is restored, the “dormant conduction” revives This revival might lead to reconnection of one or more PVs, which is the leading cause of arrhythmia recurrence after PVI [2]. It was shown that adenosine can be used to reveal dormant conduction of the PVs after PV isolation by increasing the resting potential of PV cells [1]. This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation LongTerm registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety
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