Journal of Interventional Cardiac Electrophysiology

, Volume 46, Issue 3, pp 315–324 | Cite as

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

  • Ju Youn Kim
  • Sung-Hwan KimEmail author
  • In Geol Song
  • Yoo Ri Kim
  • Tae-Seok Kim
  • Ji-Hoon Kim
  • Sung-Won Jang
  • Man Young Lee
  • Tai-Ho Rho
  • Yong-Seog OhEmail author



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).


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.


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.


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.


Adenosine Exit conduction Pulmonary vein isolation Atrial fibrillation Recurrence 



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

Compliance with ethical standards

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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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ju Youn Kim
    • 1
  • Sung-Hwan Kim
    • 1
    Email author
  • In Geol Song
    • 1
  • Yoo Ri Kim
    • 2
  • Tae-Seok Kim
    • 3
  • Ji-Hoon Kim
    • 4
  • Sung-Won Jang
    • 5
  • Man Young Lee
    • 6
  • Tai-Ho Rho
    • 5
  • Yong-Seog Oh
    • 1
    Email author
  1. 1.Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Division of Cardiology, Department of Internal Medicine, College of Medicine, Incheon St. Mary’s HospitalThe Catholic University of KoreaIncheonRepublic of Korea
  3. 3.Division of Cardiology, Department of Internal Medicine, College of Medicine, Daejeon St. Mary’s HospitalThe Catholic University of KoreaDaejeonRepublic of Korea
  4. 4.Division of Cardiology, Department of Internal Medicine, College of Medicine, St. Vincent’s HospitalThe Catholic University of KoreaSuwonRepublic of Korea
  5. 5.Division of Cardiology, Department of Internal Medicine, College of Medicine, St. Paul’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
  6. 6.Division of Cardiology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea

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