Sébastien Marchandise and Christophe Scavée contributed equally to this work.
Intravenous Adenosine to Predict Conduction Recurrence in Cavotricuspid Isthmus Early After Ablation of Typical Atrial Flutter: Myth or Reality?
Article first published online: 26 JUN 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 23, Issue 11, pages 1201–1206, November 2012
How to Cite
MARCHANDISE, S., SCAVÉE, C., BADOT, D., DECEUNINCK, O., XHAËT, O., HAUSMAN, P., MEESTER, C. D. and LE POLAIN DE WAROUX, J.-B. (2012), Intravenous Adenosine to Predict Conduction Recurrence in Cavotricuspid Isthmus Early After Ablation of Typical Atrial Flutter: Myth or Reality?. Journal of Cardiovascular Electrophysiology, 23: 1201–1206. doi: 10.1111/j.1540-8167.2012.02384.x
- Issue published online: 13 NOV 2012
- Article first published online: 26 JUN 2012
- Manuscript received 13 April 2012; Revised manuscript received 8 May 2012; Accepted for publication 15 May 2012.
- atrial flutter;
- cavotricuspid isthmus block;
- radiofrequency catheter ablation;
Adenosine and Ablation of Typical Atrial Flutter. Introduction: Early recovery of conduction (ER) after cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl) occurs in approximately 10% of the patients. If not recognized, ER might lead to AFl recurrences. In this study, we hypothesized that intravenous adenosine (iADO) can be used to predict ER in the CTI immediately after RF ablation and distinguish functional block from the complete destruction of the CTI myocardium.
Methods: We prospectively included 68 consecutive patients (age: 65 ± 14 years; male: 78%) referred in our centers for AFl ablation. Immediately after bidirectional isthmus block validation, a bolus of iADO was given during continuous pacing from the proximal coronary sinus. Patients with functional block revealed under iADO (iADO+) and those without (iADO−) were subsequently observed for a 30-minute waiting period (ER−) or until sustained recovery of the conduction through the CTI (ER+).
Results: Seven patients presented a persistent recovery (ER+, 10.3%, mean time to recovery: 14 ± 9 minutes). None of them presented even a transient resumption of conduction under iADO (iADO+: 0). With univariate analysis, we identified a heavy patient weight (>95 kg) as a predictor of ER (sensitivity: 71%).
Conclusions: Adenosine does not predict early recovery in the CTI after linear ablation for atrial flutter. We found that a patient weight over 95 kg predicted early recovery of conduction through the CTI with a sensitivity of 71%. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1201–1206, November 2012)