Manuscript received 15 July 2006; Revised manuscript received 20 November 2006; Accepted for publication 1 December 2006.
Clinical Implications of Reconnection Between the Left Atrium and Isolated Pulmonary Veins Provoked by Adenosine Triphosphate after Extensive Encircling Pulmonary Vein Isolation
Article first published online: 7 FEB 2007
Journal of Cardiovascular Electrophysiology
Volume 18, Issue 4, pages 392–398, April 2007
How to Cite
HACHIYA, H., HIRAO, K., TAKAHASHI, A., NAGATA, Y., SUZUKI, K., MAEDA, S., SASAKI, T., KAWABATA, M., ISOBE, M. and IESAKA, Y. (2007), Clinical Implications of Reconnection Between the Left Atrium and Isolated Pulmonary Veins Provoked by Adenosine Triphosphate after Extensive Encircling Pulmonary Vein Isolation. Journal of Cardiovascular Electrophysiology, 18: 392–398. doi: 10.1111/j.1540-8167.2006.00753.x
- Issue published online: 7 FEB 2007
- Article first published online: 7 FEB 2007
- extensive encircling pulmonary vein isolation;
- adenosine triphosphate;
- atrial fibrillation;
Introduction: Dormant pulmonary vein (PV) conduction can be provoked by adenosine triphosphate (ATP) after extensive encircling pulmonary vein isolation (EEPVI). However, the clinical implication of reconnection between the left atrium (LA) and isolated PVs provoked by ATP (ATP-reconnection) remains unknown.
Methods and Results: We studied the clinical consequences of ATP-reconnection during intravenous isoproterenol infusion (ISP-infusion). EEPVI severs conduction between the LA and ipsilateral PVs at their junction. Radiofrequency energy is applied at a distance from the PV ostia guided by double Lasso catheters placed within the ipsilateral superior and inferior PVs. This study comprised 82 patients (67 men, 56 ± 9 years old) with atrial fibrillation (AF) who underwent injection of ATP during ISP infusion after successful EEPVI (ATP(+) group). We compared clinical characteristics of 170 patients who underwent earlier EEPVI prior to our use of ATP injection after successful EEPVI (ATP(N/D) group) with those of ATP(+) group patients who underwent one session of EEPVI. ATP-reconnection occurred in 34 (41%) of 82 ATP(+) group patients. Additional radiofrequency applications were performed to eliminate ATP-reconnection in all ipsilateral PVs. Continuous ATP-reconnection of more than 20 seconds duration occurred in six (7.3%) of 82 patients. A total of 102 (60%) of 170 patients in the ATP(N/D) group had no recurrence of AF, whereas 60 (73%) of 82 ATP(+) group patients who underwent only one EEPVI session have had no recurrence of AF in a 6.1 ± 3.3-month follow-up period (P = 0.04).
Conclusion: Radiofrequency application for provoked ATP-reconnection may reduce clinical AF recurrence.