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Adenosine plasma level in patients with paroxysmal or persistent atrial fibrillation and normal heart during ablation procedure and/or cardioversion

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Abstract

The mechanism of atrial fibrillation (AF) in patients with normal heart remains unclear. While exogenous adenosine can trigger AF, nothing is known about the behavior of endogenous adenosine plasma level (APL) at the onset of AF and during ablation procedure. Ninety-one patients (68 with paroxysmal AF: 40 males, 66 ± 16 years; 23 with persistent AF: 14 males, 69 ± 11 years) and 18 controls were included. Among paroxysmal patients: i) medical therapy alone was performed in 45 cases and ablation procedure in 23. AF was spontaneously resolutive in 6 cases; ii) 23 underwent ablation procedure and blood was collected simultaneously in a brachial vein and in the left atrium; 17 were spontaneously in sinus rhythm while 6 were in sinus rhythm after direct current cardioversion. Among persistent patients: i) in 17 patients, blood samples were collected in a brachial vein before and after direct current cardioversion; ii) in 6 patients, blood samples were collected simultaneously in a brachial vein and in left atrium before and after cardioversion during ablation procedure. CV-APL was higher in patients with persistent AF vs patients with paroxysmal AF (median [range]: 0.9[0.6–1.1] vs 0.7[0.4–1.1] μM; p < 0.001). In patients with paroxysmal AF, LA-APL increased during the AF episode (0.95[0.85–1.4] vs 2.7[1.5–7] μM; p = 0.03) and normalized in sinus rhythm after DCCV. In patients with persistent AF, LA-APL was higher than CV-APL (1.2[0.7–1.8] vs 0.9[0.6–1.1] μM; p < 0.001), and both normalized in sinus rhythm (CV-APL: 0.8[0.6–1.1] vs 0.75[0.4–1] μM; p = 0.03), (LA-APL: 1.95[1.3–3] vs 1[0.5–1.15] μM; p = 0.03). The occurrence of AF is associated with a strong increase of APL in the atrium. The cause of this increase needs further investigations.

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Funding

Aix Marseille University and assistance Publique des Hopitaix de Marseille.

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Author notes

  1. Baptiste Maille, Marion Marlinge, Régis Guieu and Frederic Franceschi contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Timone University Hospital, 13005, Marseille, France

    Baptiste Maille, Linda Koutbi, Elsa Martinez, Jean Claude Deharo & Frederic Franceschi

  2. C2VN, INSERM, INRA, Aix Marseille Université, V2CN Marseille, Bvd P Dramard, 13015, Marseille, France

    Baptiste Maille, Marion Marlinge, Donato Vairo, Giovanna Mottola, Pierre Deharo, Marguerite Gastaldi, Claire Guiol, Pierre Michelet, Alain Boussuges, Jean Ruf, Emmanuel Fenouillet, Jean Claude Deharo, Régis Guieu & Frederic Franceschi

  3. Laboratory of Biochemistry, Timone University Hospital, 13005, Marseille, France

    Marion Marlinge, Giovanna Mottola, Marguerite Gastaldi, Patrick Mace, Mohamed Chefrour & Régis Guieu

  4. Department of Vascular Surgery, Timone University Hospital, Marseille, France

    Marine Gaudry

  5. Frederic II University, Naples, Italy

    Sara Bottone

  6. INSERM U 954 Nutrition Genetics – Environmental Risks, Nancy, France

    Rosita Gueant & Jean Louis Gueant

  7. Department of Emergency Medicine, Timone University Hospital, Marseille, France

    Pierre Michelet

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  1. Baptiste Maille
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Contributions

BM, FF, and JCD: patient inclusion, study design, and writing the paper.

GM, RG, PM, AB, and RG: study design and writing the manuscript.

MM, DV, PD, MC, PM, and CG: critical review of the paper.

EM, PM, MG, and LK: patients selection and participating in study design.

MG, PM, and MC: biological analysis and statistical analysis.

EF, JR, and JLG: critical review of the paper.

Corresponding author

Correspondence to Donato Vairo.

Ethics declarations

Conflict of interest

Baptiste Maille declares that he/she has no conflict of interest.

Marion Marlinge declares that he/she has no conflict of interest.

Donato Vairo declares that he/she has no conflict of interest.

Giovanna Mottola declares that he/she has no conflict of interest.

Linda Koutbi declares that he/she has no conflict of interest.

Pierre Deharo declares that he/she has no conflict of interest.

Marguerite Gastaldi declares that he/she has no conflict of interest.

Marine Gaudry declares that he/she has no conflict of interest.

Claire Guiol declares that he/she has no conflict of interest.

Sara Bottone declares that he/she has no conflict of interest.

Patrick Mace declares that he/she has no conflict of interest.

Rosita Gueant declares that he/she has no conflict of interest.

Mohamed Chefrour declares that he/she has no conflict of interest.

Elsa Martinez declares that he/she has no conflict of interest.

Pierre Michelet declares that he/she has no conflict of interest.

Jean Louis Gueant declares that he/she has no conflict of interest.

Alain Boussuges declares that he/she has no conflict of interest.

Jean Ruf declares that he/she has no conflict of interest.

Emmanuel Fenouillet declares that he/she has no conflict of interest.

Jean Claude Deharo declares that he/she has no conflict of interest.

Régis Guieu declares that he/she has no conflict of interest.

Frederic Franceschi declares that he/she has no conflict of interest.

Ethical approval

This study complies with the declaration of Helsinki. The study was approved by the ethical committee of the Timone University hospital. Written informed consents were obtained from all the participants.

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Maille, B., Marlinge, M., Vairo, D. et al. Adenosine plasma level in patients with paroxysmal or persistent atrial fibrillation and normal heart during ablation procedure and/or cardioversion. Purinergic Signalling 15, 45–52 (2019). https://doi.org/10.1007/s11302-018-9636-1

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