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Pacing Clin Electrophysiol. 2012 May;35(5):556-63. doi: 10.1111/j.1540-8159.2012.03356.x. Epub 2012 Mar 20.

Time course of adenosine-induced pulmonary vein reconnection after isolation: implications for mechanism of dormant conduction.

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  • 1Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York 10021, USA. jac9029@med.cornell.edu

Abstract

BACKGROUND:

Adenosine (ADO) has been proposed to reconnect isolated pulmonary veins (PVs) postablation through hyperpolarization of damaged myocytes in an animal model. However, PV reconnection can occur via ADO-mediated sympathetic activation. We sought to determine the mechanism of ADO-induced PV reconnection in the clinical setting by characterizing its time course and location in patients undergoing PV isolation.

METHODS:

Seventy-four patients (61 male; age 61 ± 10 years) undergoing PV isolation for atrial fibrillation (54 [73%] paroxysmal and 19 [27%] persistent) were studied. After each PV was isolated, a 12-mg intravenous bolus of ADO was administered and onset, offset, and location of ADO-induced PV reconnection and onset and offset of bradycardia were analyzed.

RESULTS:

In 22 (30%) patients, ADO-induced PV reconnection occurred in 34 of 270 (13%) PVs. In 24 (71%) PVs, the duration of ADO-induced reconnection exceeded that of bradycardia. The onset of ADO-induced reconnection occurred before the onset of bradycardia in 10 (30%) PVs and during bradycardia in 23 (70%) PVs. No PVs exhibited onset of reconnection after resolution of bradycardia. Common sites of PV reconnection included the carinal region (41% of right PVs and 29% of left PVs) and left PV-atrial appendageal ridge region (35% of left PVs).

CONCLUSIONS:

ADO-induced PV reconnection occurs during the bradycardic phase of the ADO bolus response and not during the late tachycardic phase. ADO-induced PV dormant conduction is closely associated with the negative dromotropic effects of ADO and suggests that hyperpolarization of the resting membrane is the unifying mechanism.

©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

[PubMed - indexed for MEDLINE]
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