Abstract 9155: Intravenous Adenosine Reveals Arrhythmogenic Foci in Patients with Atrial Fibrillation Undergoing Radiofrequency Catheter Ablation
Background: Intravenous adenosine often induces atrial fibrillation (AF). However, the role of adenosine in patients with AF undergoing radiofrequency ablation is not determined. We tested the hypothesis that intravenous adenosine reveals culprit site for AF.
Method: We included 75 consecutive patients (57 male, 62±10 years) with symptomatic AF undergoing pulmonary vein (PV) isolation for either paroxysmal (N=63) or persistent (N=12) AF in whom PV venography was performed during sinus rhythm. For PV venography, intravenous adenosine triphosphate (ATP) at a dose of 40mg was administered to produce transient asystole. We determined the incidence and origin of ectopic beats emerged after intravenous ATP utilizing simultaneous recording of the left and right superior PVs, left inferior PV, coronary sinus, right atrial free wall, septum and superior vena cava (Figure). For each PV, a straight 10-pole catheter was used to determine the longitudinal activation sequence.
Results: Repetitive beats initiating AF (RBAF) or single to triplet of premature beats (SPB) were induced within 1 minute after administration of ATP in 29 patients (39%) and 57 patients (76%), respectively. In 22 patients with RBAF from the PVs, the AF-free rate after 1.3±0.5 sessions of PVI was 86%, whereas that in 7 patients with extra-PV RBAF was 57% (P= 0.15). A total of 111 SPB origin was identified in 57 patients. The origin of 37 SPBs was in the PV, and that of the remaining 74 SPB was outside the PV. The AF-free rate in patients with SPB restricted in the PVs was 88%, and that with extra-PV SPB was 78% (P= 0.52) after PVI. In 9 patients in whom neither RBAF nor SPB was induced by ATP, AF-free rate was 67%.
Conclusion: In most patients, RBAF or SPB could be induced by intravenous ATP within 1 minute from the injection, revealing culprit site for AF. Induction of extra-PV RBAF or non-inducibility of either RBAF or SPB correlates with higher incidence of recurrence. However, extra-PV SPB is less significant.
- © 2011 by American Heart Association, Inc.