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Adenosine testing after cryoballoon pulmonary vein isolation improves long-term clinical outcome

(2012) NETHERLANDS HEART JOURNAL. 20(11). p.447-455
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Organization
Abstract
Background: Adenosine infusion after pulmonary vein isolation (PVI) with radiofrequency energy reveals dormant muscular sleeves and predicts atrial fibrillation (AF) recurrence. The aim of our study was to determine whether adenosine could reveal dormant PV sleeves after cryoballoon isolation and study its effect on long-term recurrence of AF. Methods: Patients with paroxysmal AF underwent cryoballoon PVI. After PVI, adenosine 25 mg was infused to test for dormant muscular sleeves in each vein. If reconnection under adenosine was shown, further cryoballoon ablation was performed until no more reconnection occurred. Follow-up was performed with ECG, 24-h Holter recording, and a symptom questionnaire at three monthly intervals. Transtelephonic Holter monitoring was performed for 1 month before and 3 months after PVI. Patients who underwent cryoballoon PVI without adenosine administration were used as controls for comparison. Results: In the study group (n = 34, 24 males), adenosine revealed dormant sleeves in 9/132 (8 %) veins, and 7/34 (21 %) patients. All but one vein was further treated until the dormant sleeves were isolated. During a mean follow-up of 520 +/- 147 days, 23/34 (68 %) patients were free of AF without antiarrhythmic drugs (AADs). In the control group (n = 65, 46 males), 29/65 (46 %) were free of AF without AADs. There were significantly less AF recurrences in the study group (p = 0.04). Conclusions: Adenosine administration after cryoballoon PVI reveals dormant muscular sleeves in 21 % of patients. Clinical follow-up shows that adenosine testing is effective in reducing AF recurrence after cryoballoon ablation.
Keywords
Cryoballoon, RADIOFREQUENCY CATHETER ABLATION, Adenosine, Pulmonary veins, Ablation, Atrial fibrillation, ATRIAL-FIBRILLATION, FOLLOW-UP, CRYOTHERMAL ABLATION, CONDUCTION, RECURRENCE, LESIONS

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Chicago
Van Belle, YLE, PA Janse, NMS de Groot, W Anne, DAMJ Theuns, and Luc Jordaens. 2012. “Adenosine Testing After Cryoballoon Pulmonary Vein Isolation Improves Long-term Clinical Outcome.” Netherlands Heart Journal 20 (11): 447–455.
APA
Van Belle, Y., Janse, P., de Groot, N., Anne, W., Theuns, D., & Jordaens, L. (2012). Adenosine testing after cryoballoon pulmonary vein isolation improves long-term clinical outcome. NETHERLANDS HEART JOURNAL, 20(11), 447–455.
Vancouver
1.
Van Belle Y, Janse P, de Groot N, Anne W, Theuns D, Jordaens L. Adenosine testing after cryoballoon pulmonary vein isolation improves long-term clinical outcome. NETHERLANDS HEART JOURNAL. 2012;20(11):447–55.
MLA
Van Belle, YLE et al. “Adenosine Testing After Cryoballoon Pulmonary Vein Isolation Improves Long-term Clinical Outcome.” NETHERLANDS HEART JOURNAL 20.11 (2012): 447–455. Print.
@article{8135767,
  abstract     = {Background: Adenosine infusion after pulmonary vein isolation (PVI) with radiofrequency energy reveals dormant muscular sleeves and predicts atrial fibrillation (AF) recurrence. The aim of our study was to determine whether adenosine could reveal dormant PV sleeves after cryoballoon isolation and study its effect on long-term recurrence of AF. 
Methods: Patients with paroxysmal AF underwent cryoballoon PVI. After PVI, adenosine 25 mg was infused to test for dormant muscular sleeves in each vein. If reconnection under adenosine was shown, further cryoballoon ablation was performed until no more reconnection occurred. Follow-up was performed with ECG, 24-h Holter recording, and a symptom questionnaire at three monthly intervals. Transtelephonic Holter monitoring was performed for 1 month before and 3 months after PVI. Patients who underwent cryoballoon PVI without adenosine administration were used as controls for comparison. 
Results: In the study group (n = 34, 24 males), adenosine revealed dormant sleeves in 9/132 (8 %) veins, and 7/34 (21 %) patients. All but one vein was further treated until the dormant sleeves were isolated. During a mean follow-up of 520 +/- 147 days, 23/34 (68 %) patients were free of AF without antiarrhythmic drugs (AADs). In the control group (n = 65, 46 males), 29/65 (46 %) were free of AF without AADs. There were significantly less AF recurrences in the study group (p = 0.04). 
Conclusions: Adenosine administration after cryoballoon PVI reveals dormant muscular sleeves in 21 % of patients. Clinical follow-up shows that adenosine testing is effective in reducing AF recurrence after cryoballoon ablation.},
  author       = {Van Belle, YLE and Janse, PA and de Groot, NMS and Anne, W and Theuns, DAMJ and Jordaens, Luc},
  issn         = {1568-5888},
  journal      = {NETHERLANDS HEART JOURNAL},
  keywords     = {Cryoballoon,RADIOFREQUENCY CATHETER ABLATION,Adenosine,Pulmonary veins,Ablation,Atrial fibrillation,ATRIAL-FIBRILLATION,FOLLOW-UP,CRYOTHERMAL ABLATION,CONDUCTION,RECURRENCE,LESIONS},
  language     = {eng},
  number       = {11},
  pages        = {447--455},
  title        = {Adenosine testing after cryoballoon pulmonary vein isolation improves long-term clinical outcome},
  url          = {http://dx.doi.org/10.1007/s12471-012-0319-1},
  volume       = {20},
  year         = {2012},
}

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