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MECHANISM AND LOCATION OF ADENOSINE-INDUCED PULMONARY VEIN-LEFT ATRIAL RECONNECTION FOLLOWING PULMONARY VEIN ISOLATION
E30 JACC April 5, 2011 Volume 57, Issue 14
CARDIAC ARRHYTHMIAS MECHANISM AND LOCATION OF ADENOSINE-INDUCED PULMONARY VEIN-LEFT ATRIAL RECONNECTION FOLLOWING PULMONARY VEIN ISOLATION ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 10:00 a.m.-11:15 a.m.
Session Title: Clinical Electrophysiology --Atrial Fibrillation and Flutter Abstract Category: 26. Clinical Electrophysiology—Supraventricular Arrhythmias Session-Poster Board Number: 1021-399 Authors: Jim W. Cheung, Jeffrey H. Chung, James E. Ip, Steven M. Markowitz, Christopher F. Liu, George Thomas, Bruce B. Lerman, Weill Cornell Medical College, New York, NY Background: Adenosine (ADO) has been proposed to reconnect isolated pulmonary veins (PVs) post-ablation through hyperpolarization of damaged myocytes in an animal model. However, PV reconnection can also occur via ADO-mediated sympathetic activation. We sought to determine the mechanism of ADO-induced PV reconnection in a clinical model by characterizing its time course in ablation pts. Methods: Thirty consecutive pts (23 M; age 59 ± 10 yrs) undergoing PV isolation for AF (22 (73%) paroxysmal and 8 (27%) persistent) were studied. After each PV was isolated with bidirectional block, a 12 mg IV bolus of ADO was given and the onset and location of PV reconnection were assessed. Results: In 9 (30%) pts, ADO-induced PV conduction occurred in 13/106 (12%) PVs. Transient ADO-induced PV conduction was seen with 10 PVs (mean duration 14 ± 5 s) while sustained PV reconnection was seen with 3 PVs. Onset of ADO-induced PV conduction (mean 13 ± 6 s post bolus) occurred prior to sinus slowing or AV block in 7 (54%) PVs, during sinus slowing and/or AV block in 6 (46%) PVs, and in none during the sinus tachycardia phase. PV reconnection was most commonly seen at the left atrial appendage-PV ridge of the left superior PV (23% of all reconnected PVs). Conclusions: ADO-induced PV reconnection occurs during the bradycardic phase of the ADO bolus response and not during the late tachycardic phase. This suggests that ADO-induced PV conduction is due to ADO effects on cellular resting membrane hyperpolarization and not reflex sympathetic surge.
CARDIAC ARRHYTHMIAS MECHANISM AND LOCATION OF ADENOSINE-INDUCED PULMONARY VEIN-LEFT ATRIAL RECONNECTION FOLLOWING PULMONARY VEIN ISOLATION ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 10:00 a.m.-11:15 a.m.
Session Title: Clinical Electrophysiology --Atrial Fibrillation and Flutter Abstract Category: 26. Clinical Electrophysiology—Supraventricular Arrhythmias Session-Poster Board Number: 1021-399 Authors: Jim W. Cheung, Jeffrey H. Chung, James E. Ip, Steven M. Markowitz, Christopher F. Liu, George Thomas, Bruce B. Lerman, Weill Cornell Medical College, New York, NY Background: Adenosine (ADO) has been proposed to reconnect isolated pulmonary veins (PVs) post-ablation through hyperpolarization of damaged myocytes in an animal model. However, PV reconnection can also occur via ADO-mediated sympathetic activation. We sought to determine the mechanism of ADO-induced PV reconnection in a clinical model by characterizing its time course in ablation pts. Methods: Thirty consecutive pts (23 M; age 59 ± 10 yrs) undergoing PV isolation for AF (22 (73%) paroxysmal and 8 (27%) persistent) were studied. After each PV was isolated with bidirectional block, a 12 mg IV bolus of ADO was given and the onset and location of PV reconnection were assessed. Results: In 9 (30%) pts, ADO-induced PV conduction occurred in 13/106 (12%) PVs. Transient ADO-induced PV conduction was seen with 10 PVs (mean duration 14 ± 5 s) while sustained PV reconnection was seen with 3 PVs. Onset of ADO-induced PV conduction (mean 13 ± 6 s post bolus) occurred prior to sinus slowing or AV block in 7 (54%) PVs, during sinus slowing and/or AV block in 6 (46%) PVs, and in none during the sinus tachycardia phase. PV reconnection was most commonly seen at the left atrial appendage-PV ridge of the left superior PV (23% of all reconnected PVs). Conclusions: ADO-induced PV reconnection occurs during the bradycardic phase of the ADO bolus response and not during the late tachycardic phase. This suggests that ADO-induced PV conduction is due to ADO effects on cellular resting membrane hyperpolarization and not reflex sympathetic surge.