Morales Gustavo, Darrat Yousef H, Lellouche Nicolas, Kim Sun Moon, Butt Muhammad, Bidwell Katrina, Lippert William, Ogunbayo Gbolahan, Hamon David, Di Biase Luigi, Natale Andrea, Parrott Kevin, Elayi Claude S
Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA.
Service de Cardiologie, CHU Henri Mondor, Creteil, France.
J Cardiovasc Electrophysiol. 2017 Aug;28(8):876-881. doi: 10.1111/jce.13233. Epub 2017 May 29.
Dormant conduction unmasked by adenosine predicts clinical recurrences of cavotricuspid isthmus (CTI) dependent atrial flutter following catheter ablation. Conventional practice involves a waiting period of 20 to 30 minutes after achievement of a bidirectional line of block (BDB) to monitor for recovery of conduction.
Assess whether abolition of dormant conduction with adenosine immediately after CTI ablation and BDB can predict the lack of CTI conduction recovery during the following 30 minutes.
Consecutive patients undergoing catheter ablation for CTI-dependent atrial flutter were studied. Following the completion of CTI ablation and documentation of BDB, adenosine (≥12 mg IV) was administered immediately. In cases of dormant conduction, the CTI was ablated again until its abolition. After the achievement of BDB without dormant conduction, spontaneous CTI reconnection during the following 30 minutes and dormant conduction with adenosine at 30 minutes were evaluated.
A CTI block was achieved in 171 patients. Nine patients (5.3%) had dormant conduction across the CTI immediately after ablation and BDB, and required further ablation. Two patients (1.2%) had subsequent spontaneous time-dependent reconnection within 30 minutes. Two other patients (1.2%) developed late dormant conduction with adenosine at 30 minutes. All 4 patients underwent further ablation.
A negative adenosine challenge immediately after CTI ablation with bidirectional block, or after abolition of dormant conduction with further ablation, strongly predicted the absence of subsequent spontaneous reconnection within 30 minutes. Based on these results, the conventional waiting period is unnecessary in 97.6% patients without dormant conduction after CTI-dependent flutter ablation.
腺苷揭示的隐匿性传导可预测导管消融术后三尖瓣峡部（CTI）依赖性房扑的临床复发。传统做法是在实现双向阻滞（BDB）后等待20至30分钟，以监测传导恢复情况。
评估CTI消融和BDB后立即用腺苷消除隐匿性传导是否可预测接下来30分钟内CTI传导不会恢复。
对连续接受CTI依赖性房扑导管消融的患者进行研究。在完成CTI消融并记录BDB后，立即静脉注射腺苷（≥12 mg）。若存在隐匿性传导，则再次消融CTI直至其消除。在实现无隐匿性传导的BDB后，评估接下来30分钟内CTI的自发重新连接情况以及30分钟时腺苷诱发的隐匿性传导情况。
171例患者实现了CTI阻滞。9例患者（5.3%）在消融和BDB后立即存在CTI隐匿性传导，需要进一步消融。2例患者（1.2%）在30分钟内出现了随后的自发时间依赖性重新连接。另外2例患者（1.2%）在30分钟时出现了腺苷诱发的延迟隐匿性传导。所有4例患者均接受了进一步消融。
CTI消融并双向阻滞或在进一步消融消除隐匿性传导后立即进行腺苷激发试验结果为阴性，强烈提示接下来30分钟内不会出现后续自发重新连接。基于这些结果，对于97.6%的CTI依赖性房扑消融后无隐匿性传导的患者，无需进行传统的等待期。
