Reconnection rate and long-term outcome with adenosine provocation during cryoballoon ablation for pulmonary vein isolation

Rachel M. Kaplan, Sanjay Dandamudi, Martha Bohn, Nishant Verma, Todd T. Tomson, Rishi Arora, Alexandru B. Chicos, Jeffrey Goldberger, Susan S. Kim, Bradley P. Knight, Albert C. Lin, Rod S. Passman

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Adenosine can unmask dormant conduction during pulmonary vein isolation (PVI) for atrial fibrillation (AF). Studies of adenosine use in radiofrequency PVI show high reconnection rates and conflicting results for long-term success, however there is limited data with cryoballoon ablation (CBA). Methods: A prospectively maintained database of patients undergoing first CBA at a single institution was analyzed. Adenosine use was at the discretion of the primary operator. Additional freezes were delivered for reconnected veins until dormant conduction was eliminated. The primary endpoint, time to AF recurrence defined as any episode < 30 seconds after a 3-month blanking period, was assessed by Kaplan-Meier analysis. Results: From 2011 to 2015, 406 patients underwent CBA, 361 of whom had > 3 months follow-up. The mean age was 61.7 years, 69% were male, and the prevalence of paroxysmal AF was 79% with no significant difference between those that did and did not receive adenosine (77% vs 86%, respectively, p = 0.23). Adenosine testing was performed in 78 patients (21.6%) with a mean dose of 10.6 mg/vein. Of the 306 veins evaluated, 17 (6%) demonstrated dormant conduction. Over a median 14.4 months follow-up, there was no significant difference in freedom from AF with adenosine use (p= 0.86). Conclusions: Dormant conduction with adenosine is uncommon following CBA and its use does not improve long-term success rates.

Original languageEnglish (US)
JournalJournal of Atrial Fibrillation
Volume9
Issue number5
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

Fingerprint

Pulmonary Veins
Adenosine
Atrial Fibrillation
Veins
Databases
Recurrence

Keywords

  • Adenosine
  • Atrial fibrillation
  • Atrial fibrillation (AF)
  • Cryoballoon ablation
  • Cryoballoon ablation (CBA)
  • Intracardiac echocardiography (Ice)
  • Pulmonary vein isolation (PVI)
  • Pulmonary vein isolation abbreviations
  • Radiofrequency ablation (Rfa)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Reconnection rate and long-term outcome with adenosine provocation during cryoballoon ablation for pulmonary vein isolation. / Kaplan, Rachel M.; Dandamudi, Sanjay; Bohn, Martha; Verma, Nishant; Tomson, Todd T.; Arora, Rishi; Chicos, Alexandru B.; Goldberger, Jeffrey; Kim, Susan S.; Knight, Bradley P.; Lin, Albert C.; Passman, Rod S.

In: Journal of Atrial Fibrillation, Vol. 9, No. 5, 01.02.2017.

Research output: Contribution to journalArticle

Kaplan, RM, Dandamudi, S, Bohn, M, Verma, N, Tomson, TT, Arora, R, Chicos, AB, Goldberger, J, Kim, SS, Knight, BP, Lin, AC & Passman, RS 2017, 'Reconnection rate and long-term outcome with adenosine provocation during cryoballoon ablation for pulmonary vein isolation', Journal of Atrial Fibrillation, vol. 9, no. 5. https://doi.org/10.4022/jafib.1510
Kaplan, Rachel M. ; Dandamudi, Sanjay ; Bohn, Martha ; Verma, Nishant ; Tomson, Todd T. ; Arora, Rishi ; Chicos, Alexandru B. ; Goldberger, Jeffrey ; Kim, Susan S. ; Knight, Bradley P. ; Lin, Albert C. ; Passman, Rod S. / Reconnection rate and long-term outcome with adenosine provocation during cryoballoon ablation for pulmonary vein isolation. In: Journal of Atrial Fibrillation. 2017 ; Vol. 9, No. 5.
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abstract = "Background: Adenosine can unmask dormant conduction during pulmonary vein isolation (PVI) for atrial fibrillation (AF). Studies of adenosine use in radiofrequency PVI show high reconnection rates and conflicting results for long-term success, however there is limited data with cryoballoon ablation (CBA). Methods: A prospectively maintained database of patients undergoing first CBA at a single institution was analyzed. Adenosine use was at the discretion of the primary operator. Additional freezes were delivered for reconnected veins until dormant conduction was eliminated. The primary endpoint, time to AF recurrence defined as any episode < 30 seconds after a 3-month blanking period, was assessed by Kaplan-Meier analysis. Results: From 2011 to 2015, 406 patients underwent CBA, 361 of whom had > 3 months follow-up. The mean age was 61.7 years, 69{\%} were male, and the prevalence of paroxysmal AF was 79{\%} with no significant difference between those that did and did not receive adenosine (77{\%} vs 86{\%}, respectively, p = 0.23). Adenosine testing was performed in 78 patients (21.6{\%}) with a mean dose of 10.6 mg/vein. Of the 306 veins evaluated, 17 (6{\%}) demonstrated dormant conduction. Over a median 14.4 months follow-up, there was no significant difference in freedom from AF with adenosine use (p= 0.86). Conclusions: Dormant conduction with adenosine is uncommon following CBA and its use does not improve long-term success rates.",
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T1 - Reconnection rate and long-term outcome with adenosine provocation during cryoballoon ablation for pulmonary vein isolation

AU - Kaplan, Rachel M.

AU - Dandamudi, Sanjay

AU - Bohn, Martha

AU - Verma, Nishant

AU - Tomson, Todd T.

AU - Arora, Rishi

AU - Chicos, Alexandru B.

AU - Goldberger, Jeffrey

AU - Kim, Susan S.

AU - Knight, Bradley P.

AU - Lin, Albert C.

AU - Passman, Rod S.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background: Adenosine can unmask dormant conduction during pulmonary vein isolation (PVI) for atrial fibrillation (AF). Studies of adenosine use in radiofrequency PVI show high reconnection rates and conflicting results for long-term success, however there is limited data with cryoballoon ablation (CBA). Methods: A prospectively maintained database of patients undergoing first CBA at a single institution was analyzed. Adenosine use was at the discretion of the primary operator. Additional freezes were delivered for reconnected veins until dormant conduction was eliminated. The primary endpoint, time to AF recurrence defined as any episode < 30 seconds after a 3-month blanking period, was assessed by Kaplan-Meier analysis. Results: From 2011 to 2015, 406 patients underwent CBA, 361 of whom had > 3 months follow-up. The mean age was 61.7 years, 69% were male, and the prevalence of paroxysmal AF was 79% with no significant difference between those that did and did not receive adenosine (77% vs 86%, respectively, p = 0.23). Adenosine testing was performed in 78 patients (21.6%) with a mean dose of 10.6 mg/vein. Of the 306 veins evaluated, 17 (6%) demonstrated dormant conduction. Over a median 14.4 months follow-up, there was no significant difference in freedom from AF with adenosine use (p= 0.86). Conclusions: Dormant conduction with adenosine is uncommon following CBA and its use does not improve long-term success rates.

AB - Background: Adenosine can unmask dormant conduction during pulmonary vein isolation (PVI) for atrial fibrillation (AF). Studies of adenosine use in radiofrequency PVI show high reconnection rates and conflicting results for long-term success, however there is limited data with cryoballoon ablation (CBA). Methods: A prospectively maintained database of patients undergoing first CBA at a single institution was analyzed. Adenosine use was at the discretion of the primary operator. Additional freezes were delivered for reconnected veins until dormant conduction was eliminated. The primary endpoint, time to AF recurrence defined as any episode < 30 seconds after a 3-month blanking period, was assessed by Kaplan-Meier analysis. Results: From 2011 to 2015, 406 patients underwent CBA, 361 of whom had > 3 months follow-up. The mean age was 61.7 years, 69% were male, and the prevalence of paroxysmal AF was 79% with no significant difference between those that did and did not receive adenosine (77% vs 86%, respectively, p = 0.23). Adenosine testing was performed in 78 patients (21.6%) with a mean dose of 10.6 mg/vein. Of the 306 veins evaluated, 17 (6%) demonstrated dormant conduction. Over a median 14.4 months follow-up, there was no significant difference in freedom from AF with adenosine use (p= 0.86). Conclusions: Dormant conduction with adenosine is uncommon following CBA and its use does not improve long-term success rates.

KW - Adenosine

KW - Atrial fibrillation

KW - Atrial fibrillation (AF)

KW - Cryoballoon ablation

KW - Cryoballoon ablation (CBA)

KW - Intracardiac echocardiography (Ice)

KW - Pulmonary vein isolation (PVI)

KW - Pulmonary vein isolation abbreviations

KW - Radiofrequency ablation (Rfa)

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U2 - 10.4022/jafib.1510

DO - 10.4022/jafib.1510

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JO - Journal of Atrial Fibrillation

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