Kumar Narendra, Dinh Trang, Phan Kevin, Timmermans Carl, Philippens Suzanne, Dassen Willem, Vranken Nousjka, Pison Laurent, Maessen Jos, Crijns Harry J
Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands
Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht 6202 AZ, The Netherlands.
Europace. 2015 Jun;17(6):871-6. doi: 10.1093/europace/euu352. Epub 2015 May 12.
Adenosine administration after pulmonary vein (PV) isolation using radiofrequency, laser, and cryoablation can cause acute recovery of conduction to the PVs and predict atrial fibrillation (AF) recurrence. This study evaluates whether ablation of dormant potentials post-adenosine administration following second-generation cryoballoon (CB-2G) ablation may improve the success rate for AF.
In 45 of 90 patients after a waiting period of 30 min, a bolus 15-21 mg of adenosine was administered followed by rapid saline flush. The response was assessed for each PV using a circular octapolar catheter. If needed, further ablation using a cryoballoon and/or cryocatheter was performed until no reconduction was observed after repeat adenosine administration. The remaining 45 patients did not receive adenosine after the procedure. Acute PV isolation was achieved in 352 of 358 PVs (98.3%) of 86 of 90 patients (95.6%) using CB-2G. The adenosine group showed dormant reconduction in 5 of 45 patients (11%), 8 of 179 PVs (4.5%), including 1 left superior pulmonary vein, 3 left inferior pulmonary vein, 1 right superior pulmonary vein, and 3 right inferior pulmonary vein. The success rate for adenosine and without adenosine group was 84 and 79%, respectively, after a mean follow-up of 397 ± 47 and 349 ± 66 days, without any AF recurrence in patients in whom adenosine-induced dormant conduction was ablated.
Adenosine testing after second-generation cryoballoon ablation study showed that reablation of initially isolated PVs increases the clinical success rate for AF.
在使用射频、激光和冷冻消融进行肺静脉（PV）隔离后给予腺苷可导致PV传导急性恢复，并预测房颤（AF）复发。本研究评估第二代冷冻球囊（CB-2G）消融后给予腺苷后对休眠电位进行消融是否可提高AF的成功率。
90例患者中有45例在等待30分钟后给予15 - 21mg腺苷推注，随后快速生理盐水冲洗。使用环形八极导管对每个PV的反应进行评估。如有需要，使用冷冻球囊和/或冷冻导管进行进一步消融，直至重复给予腺苷后未观察到再传导。其余45例患者术后未接受腺苷。使用CB-2G在90例患者中的86例（95.6%）的358条PV中的352条（98.3%）实现了急性PV隔离。腺苷组45例患者中有5例（11%）、179条PV中有8条（4.5%）出现休眠再传导，包括1条左上肺静脉、3条左下肺静脉、1条右上肺静脉和3条右下肺静脉。平均随访397±47天和349±66天后，腺苷组和未用腺苷组的成功率分别为84%和79%，在消融了腺苷诱导的休眠传导的患者中无AF复发。
第二代冷冻球囊消融术后的腺苷测试表明，对最初隔离的PV进行再次消融可提高AF的临床成功率。
