Clinical significance of elimination of dormant pulmonary vein conduction revealed by adenosine after pulmonary vein isolation: 3-year follow-up

Abstract

Purpose: This study evaluated the impact of elimination of Adenosine-Triphospatis (ATP)-induced dormant Pulmonary Vein (PV) conduction on the clinical outcome after PV isolation in patients with Atrial Fibrillation (AF). Methods: Study included 134 patients with paroxysmal (25%) and persistent (75%)AF. After antral PV isolation, 30 minutes observation period was applied. All acute PV reconnections were eliminated and then ATP-test was performed to reveal dormant conduction. In case of dormant conduction patients were randomized to 2 groups. Dormant conduction was eliminated by additional ablations in all patients of ATP-Abl group and remained intact in ATP-Control group. During follow-up period each patient was given antiarrhythmic drugs for 3 months. Results: After initial PV isolation and observation period ATP-test revealed dormant conduction in 33 out of 268 ipsilateral PV pairs (12%) in 31 patients (23%). ATP-Abl group included 14 patients, in whom all dormant conduction were eliminated by additional ablations in 15 ipsilateral PV pairs. ATP-Control group included 17 patients, in whom dormant conduction was revealed in 18 ipsilateral PV pairs, but left intacted. After 40 months follow-up 6 patients in ATP-Abl group (43%) and 6 patients in ATP-Control group (35%) were free from any arrhythmia (Log Rank test, p=0,39). ![Figure][1] Kaplan-Meier curves of freedom from AF Conclusion: After the application of 30 minutes observation period and reablation of all acute reconnections, dormant PV conduction was revealed in one fourth of the patients. Elimination of dormant PV conduction does not increase long-term freedom from AF. [1]: pending:yes