Clinical characteristics and outcomes of adenosine induced atrial fibrillation after pulmonary vein isolation

초록

Introduction: Adenosine (ADE) has been used to identify dormant pulmonary vein (PV) conduction after PV isolation (PVI) in patients with atrial fibrillation (AF). ADE is also known to have a potential to induce AF, even it was rarely reported. The mechanism responsible for ADE induced AF is not clearly known. Previous reports suggested that ADE induced proarrhythmic effects through shortening atrial action potential duration and refractoriness. Recently ADE is known to result in AF as in vagally mediated AF, in which acetylcholine like signal transduction cascade via specific G protein-coupled receptor mediated. This study presented 12 cases with ADE induced AF and clinical outcomes of these patients after PVI. Methods: Total 141 consecutive patients (87% male, 55±10 years) with AF who underwent PVI and PV dormant conduction test with 12mg ADE were included. Among them, AF was induced in 12 patients (8.5%) within 2 minutes after ADE. Results: The patients diagnosed as paroxysmal AF were 78.7% and the others as non-paroxysmal AF were 21.3%. The dormant PV conduction after intravenous ADE challenge was observed in 20.6% of patients. The ADE induced AF was documented in 12 (8.5%) patients. The sites harboring trigger of ADE induced AF were variable, including PV inside (n=6), vein of Marshall (n=3), coronary sinus (n=1), right atrial septum (n=2), right atrial crista terminalis (n=2), superior vena cava (n=1) and right atrial appendage (n=1). All 12 patients (male 75.0%, age 52.5±2.8) with ADE induced AF had a paroxysmal AF and underwent additional ablation until AF was no longer induced. The recurrence rate of these patients was 25% and that of patients (male 88.4%, age 55.4±0.9) without ADE induced AF was 12.9% (p=0.449). Conclusion: ADE induced AF occurred in 8.5% of patients while testing dormant conduction after PVI and only in patients diagnosed as paroxysmal AF. The recurrence rate of these patients was 25%, which is higher trend than that of patients without ADE induced AF was 12.9% (p=0.449). Further study including larger number of the patients with longer follow up is warranted to see clinical significance of ADE induced AF post-PVI.