Differential Effects of Adenosine on Pulmonary Vein Ectopy Following Pulmonary Vein Isolation: Implications for Arrhythmogenesis

Circep.ahajournals.org:  June 23, 2012.

Background—The mechanism of pulmonary vein (PV) triggers of atrial fibrillation (AF) remains unclear. We performed adenosine (ADO) testing following PV isolation to characterize spontaneous dissociated PV rhythm and ADO-induced PV ectopy.

Methods and Results—Seventy-four patients (61 male; age 61 ± 10 years) undergoing PV isolation for AF were studied. For each isolated PV, dissociated ectopy was recorded and ADO was administered. After isolation of 270 PVs, 50 PVs with dissociated ectopy were identified. In 42 PVs exhibiting PV rhythm, ADO resulted in PV rhythm suppression in 35 (83%) PVs, with all occurring during ADO-induced bradycardia and in PV rhythm acceleration in 13 (31%) PVs, with all occurring after resolution of ADO-induced bradycardia. In 11 PVs, both ADO-induced PV rhythm acceleration and suppression were seen. Among 220 electrically silent PVs, ADO induced PV ectopy in 28 (13%) veins. The timing of ADO-induced PV ectopy with respect to ADO effects on heart rate varied. ADO induced PV ectopy in 12 PVs during early phase of ADO effect only, in 8 PVs during late phase of ADO effect only and in 8 PVs during both early and late phases of ADO effect. Read More