Abstract 13596: Adenosine-Induced Pulmonary Vein Ectopy as a Predictor of Recurrent Atrial Fibrillation Following Pulmonary Vein Isolation
Background: Adenosine (ADO) has been used to unmask dormant conduction following pulmonary vein (PV) isolation. We have shown that ADO can induce ectopy in electrically silent PVs following PV isolation, possibly via activation of autonomic triggers. We sought to identify the clinical significance of ADO-induced PV ectopy following PV isolation.
Methods: A total of 107 pts (84 M; mean age 60 ± 10 yrs) undergoing PV isolation for AF were studied. After each PV was isolated, any spontaneous dissociated PV ectopy was noted. ADO (12 mg IV bolus) was given and any ADO-induced PV reconnection and ADO-induced PV ectopy was recorded. All dormant conduction was targeted with additional ablation. Pts were followed for AF recurrence (defined as AT/AF ≥ 30 seconds).
Results: A total of 398 PVs were isolated in the study pts. Following PV isolation, 81(20%) PVs exhibited spontaneous dissociated ectopy, 51 (13%) PVs had ADO-induced PV reconnection and 45 (11%) PVs had ADO-induced PV ectopy. After mean follow-up of 384 ± 129 ds, 36 (34%) pts had recurrent AF. The rate of recurrent AF among pts with ADO-induced PV ectopy was significantly higher than those without ADO-induced PV ectopy (48% [15 of 31 pts] vs. 28% [21 of 76 pts]; p = 0.039). The rates of recurrent AF among pts with and without spontaneous dissociated PV ectopy (29% vs. 37%; p = 0.37) and among pts with and without dormant conduction (35% vs. 33%; p = 0.81) were not significantly different. Among the clinical variables assessed including age, type of AF, LVEF, and LA size, the presence of ADO-induced PV ectopy was the only significant predictor of recurrent AF following PV isolation (HR 2.2; 95% CI 1.1 - 4.2; p = 0.023).
Conclusions: ADO-induced PV ectopy, but not ADO-induced PV reconnection, is a significant predictor of AF recurrence following PV isolation when dormant conduction is targeted with additional ablation. The presence of ADO-induced PV ectopy may be a marker of PV arrhythmogenicity following ablation.
- © 2012 by American Heart Association, Inc.