Adenosine-Guided Pulmonary Vein Antral Isolation for Paroxysmal Atrial Fibrillation: A Randomized Study

Autor:	Konstantinos P. Letsas, Antonios Sideris, Louiza Lioni, George Giannopoulos, Michael Efremidis, Konstantinos Vlachos, Tong Liu, Eleni Geladari, Stamatis Georgopoulos, Spyridon Deftereos, Athanasios Saplaouras
Rok vydání:	2016
Předmět:	medicine.medical_specialty business.industry Hazard ratio Atrial fibrillation 030204 cardiovascular system & hematology medicine.disease Confidence interval Pulmonary vein law.invention Log-rank test 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Physiology (medical) Anesthesia Internal medicine Cohort Cardiology medicine 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Survival analysis
Zdroj:	Journal of Cardiovascular Electrophysiology. 27:1288-1292
ISSN:	1045-3873
DOI:	10.1111/jce.13059
Popis:	Objectives The prognostic significance of adenosine-mediated pulmonary vein dormant conduction and whether such conduction should be eliminated still remain controversial. This randomized study aimed to investigate whether adenosine-guided ablation of the reconnection gaps improves the long-term outcomes of pulmonary vein antral isolation (PVAI) for paroxysmal atrial fibrillation (AF). Methods and results Consecutive patients with paroxysmal AF were randomly assigned to undergo (n = 80, group 1) or not (n = 81, group 2) adenosine testing following PVAI. Adenosine-mediated pulmonary vein dormant conduction was unmasked in 26 patients (32.5%) of group 1. Successful elimination of the reconnection gaps was subsequently performed in all patients. During a mean follow-up period of 11.39±5.10 months, 30 patients of group 1 (37.5%) and 27 patients of group 2 (33.3%) experienced arrhythmia recurrence. The Kaplan-Meier arrhythmia free survival curves failed to demonstrate any significant differences between study groups (log rank 0.217, p = 0.642). Fourteen out of 26 (53.8%) patients with adenosine-mediated dormant conduction and subsequent elimination of reconnection gaps experienced AF recurrence during follow-up. On the contrary, only 16 out of 54 patients without dormant conduction (29.6%) displayed arrhythmia recurrence (p: 0.049). Logistic regression analysis showed that adenosine-mediated PV reconnection (hazard ratio 0.292, 95% confidence interval 0.122-0.483; p: 0.01) was an independent predictor of AF recurrence. Conclusion In this patients’ cohort, adenosine-mediated pulmonary vein reconnection is predictive of future arrhythmic events. Elimination of dormant conduction with additional ablation lesions does not improve the long-term outcome of the procedure compared to the standard PVAI. This article is protected by copyright. All rights reserved
Databáze:	OpenAIRE
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