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Achievement of successful pulmonary vein isolation: methods of adenosine testing and incremental benefit of exit block

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Abstract

Purpose

Several approaches were tried to achieve complete pulmonary vein isolation (PVI). The aims of this study were to (1) compare adenosine-induced PV conduction and exit conduction, (2) determine the adequate adenosine dose, and (3) investigate the correlation of dormant conduction and recurrence of atrial fibrillation (AF).

Methods

A total of 378 consecutive patients who underwent PVI from June 2012 to April 2015 were prospectively included (the de novo procedure in 318 (84.1 %) and a redo procedure in 60 (15.9 %)). After the exit block was assessed, 20 mg adenosine was injected into the left atrium. If dormant conduction was observed, 12 and 6 mg of adenosine were injected sequentially.

Results

Exit conduction during PV pacing was observed in 34 patients (9 %), and dormant conduction was observed in 92 patients (24.3 %). Among them, 74 (80.4 %, 74/92) demonstrated dormant conduction without exit conduction and 16 (47.1 %, 16/34) showed exit conduction without dormant conduction. The 20-mg dose of adenosine had an additive yield in patients with dormant conduction, compared to that of 12 mg (93 %, 86/92) or 6 mg (80 %, 74/92). There was no significant difference in the recurrence rate regarding dormant conduction. The pattern of prevalence of reconnected origin during the redo procedure was similar to that of dormant conduction during the index procedure.

Conclusions

There was a discrepancy between adenosine-induced PVI and exit block. Therefore, exit block test has additional value to verify latent incomplete PVI in conjunction with adenosine test. Furthermore, high-dose adenosine had an additive yield.

Clinical trial registration

https://www.clinicaltrials.gov/ct2/show/NCT01932112

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Acknowledgments

We thank Jeong-Wook Park, Young-Woong Ha, Bo-Kyung Kim, and Inae Jung for their technical support and patient care and reporting.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea

    Ju Youn Kim, Sung-Hwan Kim, In Geol Song & Yong-Seog Oh

  2. Division of Cardiology, Department of Internal Medicine, College of Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea

    Yoo Ri Kim

  3. Division of Cardiology, Department of Internal Medicine, College of Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon, Republic of Korea

    Tae-Seok Kim

  4. Division of Cardiology, Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea

    Ji-Hoon Kim

  5. Division of Cardiology, Department of Internal Medicine, College of Medicine, St. Paul’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Sung-Won Jang & Tai-Ho Rho

  6. Division of Cardiology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Man Young Lee

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  1. Ju Youn Kim
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Corresponding authors

Correspondence to Sung-Hwan Kim or Yong-Seog Oh.

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Conflict of interest

None declared.

Ethical approval

All procedures performed in the present study were in accordance with the ethical standards of the institutional review board of the Catholic Medical Center, South Korea.

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Kim, J.Y., Kim, SH., Song, I.G. et al. Achievement of successful pulmonary vein isolation: methods of adenosine testing and incremental benefit of exit block. J Interv Card Electrophysiol 46, 315–324 (2016). https://doi.org/10.1007/s10840-016-0122-9

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  • DOI: https://doi.org/10.1007/s10840-016-0122-9

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