Late reconnection site in the second session after pulmonary vein isolation using adenosine-provocation for atrial fibrillation

Abstract

Purpose: An intravenous adenosine triphosphate (ATP) administration could reveal the dormant conduction (DC) gaps on the ablation line of a pulmonary vein isolation (PVI). The objective of this study was to examine the ATP-provoked DC sites after the initial PVI, and compare those findings to the PVs re-conduction sites in the second session in patients with paroxysmal atrial fibrillation (AF). Methods: We performed a multicenter, observational study from a prospective registry undergoing AF ablation. A total of 110 consecutive drug-refractory paroxysmal AF patients (62.1±9 years) were enrolled in this study. DC was detected by an intravenous adenosine triphosphate (ATP) provocation of up to 40 mg during a continuous isoproterenol infusion (0.5-2μg/ min). The DC sites of each right and left PV were precisely determined by using double spiral catheters under the guidance of a 3-dimensional (3D) constructed anatomical mapping system. We followed up these patients for a median of 27.1 months. Results: In the initial session, DC was observed in 35 patients (31.8%, 1.3 gaps /patient), and the sites of the DC were commonly observed in the carina region (43.5%). AF recurrence was confirmed in 33 patients (30.9%) after the initial session, and a second session was performed in 24 of 33 patients (70.6%). In the second session, the re-conduction sites were also commonly observed in the carina region (59.5%). ![Figure][1] Distribution of DC and reconnection site Conclusions: The carina region was still a dominant re-conduction site even after the elimination of any ATP-provoked DC. [1]: pending:yes