A machine-learning algorithm to predict atrial fibrillation recurrence after a pulmonary vein isolation procedure

Abstract Background Contemporary risk models to predict the recurrence of atrial fibrillation (AF) after pulmonary vein isolation have limited predictive ability. Models with high specificity seem particularly suited for the setting of AF ablation, where they could be used as gatekeepers to withhold intervention in patients with low likelihood of success. Machine learning (ML) has the potential to identify complex nonlinear patterns within datasets, improving the predictive power of models. This study sought to determine whether ML can be used to better identify patients who will relapse within one year of an AF ablation procedure. Methods We assessed 484 patients (294 men, mean age 61±12 years, 76% with paroxysmal AF) who underwent radiofrequency pulmonary vein isolation (PVI) for symptomatic drug-refractory AF. Using this dataset, a machine-learning model based on Support Vector Machines (SVM) was developed to predict AF recurrence within one year of the procedure. The following variables were used to feed the model: type of AF (paroxysmal vs. non-paroxysmal), previous ablation procedure, left atrium (LA) volume, and epicardial fat volume (both derived from pre-ablation cardiac CT). The algorithm was trained in a random sample of 70% of the study population (n=339) and tested in the remainder 30% (n=145). Results A total of 130 patients (27%) suffered AF recurrence within one year of the procedure. The ML model predicted AF recurrence with 75% accuracy (95% CI 67–82%), yielding a sensitivity and specificity of 25% (95% CI 13–41%) and 94% (95% CI 88–98%), respectively. The corresponding positive and negative predictive values were 62% (95% CI 39–81%) and 77% (95% CI 67–82%), respectively. The relative weight of the variables in the ML model was: epicardial fat 56%, type of AF 23%, previous ablation 14%, and LA volume 7%. A high-risk subgroup representing 10.8% of patients was identified with the ML algorithm. In this subgroup, one-year recurrence was 62%, representing 24% of the total number of recurrences. Conclusion A machine-learning model showed high specificity in the identification of patients who relapse during the first year after AF ablation. In the future, these tools may be useful to improve patient selection. Funding Acknowledgement Type of funding source: None

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Abstract 15934: Comparison of Atrial Fibrillation Burden Reduction in Patients With Paroxysmal and Persistent Atrial Fibrillation Undergoing Cryoballoon Pulmonary Vein Isolation

Circulation ◽

10.1161/circ.142.suppl_3.15934 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Dan L Musat ◽

Nicolle S Milstein ◽

Jacqueline Pimienta ◽

Advay Bhatt ◽

Tina C Sichrovsky ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Persistent Atrial Fibrillation ◽

Loop Recorder ◽

Similar Reduction ◽

Af Ablation ◽

Ablation Success ◽

One Year ◽

Af Recurrence

Background: Pulmonary vein isolation (PVI) is a cornerstone of atrial fibrillation (AF) ablation procedures to treat symptomatic AF. Ablation success is defined by absence of AF recurrence >30 seconds. However, reduction in AF burden (AFB) is also an important endpoint. Whether patients with paroxysmal (PAF) and persistent AF (PeAF) have similar reduction in AFB post-ablation is unknown. Objective: To compare the decrease in AFB following cryoballoon (CB) PVI in patients with PAF and PeAF. Methods: We enrolled consecutive pts with an implantable loop recorder (ILR) who subsequently underwent CB PVI. All patients were followed prospectively for at least one year, or until repeat ablation; we compared AFB pre and post-ablation. Results: The cohort included had 47 patients (66 ± 10 years; 32 [68%] male; PAF [n=23, 49%]; CHA 2 DS 2 -VASc 2.7 ± 1.7, 34 [72%] on AAD at the time of ablation). A median of 136 days [IQR 280, 73; minimum of 30 days] of ILR data pre-ablation were available. The median AFB for PAF was 4.7% [IQR 0.9, 14.8] and PeAF was 6.8% [IQR 1.1, 40.4]. After excluding a 3-month post-ablation blanking period, recurrent AF occurred in 12 (52%) PAF and 11 (46%) PeAF patients. The median AFB post-ablation for PAF and PeAF cohorts was 0.03%, [IQR 0, 0.3] and 0.04%, [IQR 0, 1.1], respectively. This represents a >99% reduction in AFB. Conclusion: Although 50% of patients undergoing CB PVI for PAF or PeAF had a recurrence of AF, there was >99% reduction in AFB in both groups. These data highlight the importance of using AFB burden as a marker of therapeutic efficacy post-AF ablation.

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Preprocedure Application of Machine Learning and Mechanistic Simulations Predicts Likelihood of Paroxysmal Atrial Fibrillation Recurrence Following Pulmonary Vein Isolation

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.119.008213 ◽

2020 ◽

Vol 13 (7) ◽

Cited By ~ 2

Author(s):

Julie K. Shade ◽

Rheeda L. Ali ◽

Dante Basile ◽

Dan Popescu ◽

Tauseef Akhtar ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Machine Learning ◽

Atrial Fibrillation ◽

Magnetic Resonance ◽

Computational Modeling ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Area Under The Curve ◽

Resonance Imaging ◽

Af Recurrence

Background: Pulmonary vein isolation (PVI) is an effective treatment strategy for patients with atrial fibrillation (AF), but many experience AF recurrence and require repeat ablation procedures. The goal of this study was to develop and evaluate a methodology that combines machine learning (ML) and personalized computational modeling to predict, before PVI, which patients are most likely to experience AF recurrence after PVI. Methods: This single-center retrospective proof-of-concept study included 32 patients with documented paroxysmal AF who underwent PVI and had preprocedural late gadolinium enhanced magnetic resonance imaging. For each patient, a personalized computational model of the left atrium simulated AF induction via rapid pacing. Features were derived from pre-PVI late gadolinium enhanced magnetic resonance images and from results of simulations of AF induction. The most predictive features were used as input to a quadratic discriminant analysis ML classifier, which was trained, optimized, and evaluated with 10-fold nested cross-validation to predict the probability of AF recurrence post-PVI. Results: In our cohort, the ML classifier predicted probability of AF recurrence with an average validation sensitivity and specificity of 82% and 89%, respectively, and a validation area under the curve of 0.82. Dissecting the relative contributions of simulations of AF induction and raw images to the predictive capability of the ML classifier, we found that when only features from simulations of AF induction were used to train the ML classifier, its performance remained similar (validation area under the curve, 0.81). However, when only features extracted from raw images were used for training, the validation area under the curve significantly decreased (0.47). Conclusions: ML and personalized computational modeling can be used together to accurately predict, using only pre-PVI late gadolinium enhanced magnetic resonance imaging scans as input, whether a patient is likely to experience AF recurrence following PVI, even when the patient cohort is small.

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Predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation

EP Europace ◽

10.1093/europace/euab116.231 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

MJ Mulder ◽

MJB Kemme ◽

LHGA Hopman ◽

E Kusgozoglu ◽

H Gulcicek ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Roc Curve ◽

Predictive Value ◽

Risk Scores ◽

Adverse Event Rate ◽

Af Ablation ◽

Procedural Complications ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Predicting who will or will not benefit from AF ablation is challenging. Although various risk scores have been designed to predict outcomes after AF ablation, comparative data are sparse and external risk score validation is often lacking. Purpose In this study, we aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications. Methods A total of 482 AF patients (37% non-paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (RF-PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography and either cardiac computed tomography imaging or cardiac magnetic resonance imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF2, CAAP-AF, CHADS2, CHA2DS2-VASc, DR-FLASH, HATCH, LAGO and MB-LATER. The predictive performance of the risk scores for AF recurrence and complications were assessed separately by receiver operating characteristic (ROC) curves. Results Median follow-up was 16 (12-31) months. AF recurrence after the 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124-360) days after ablation. Overall procedural adverse event rate was 6%. The HATCH score was the only score without predictive value for recurrent AF after ablation (area under curve [AUC] 0.545). All other investigated scores demonstrated statistically significant but poor predictive value for recurrent AF after ablation (AUC 0.553-0.669). CHA2DS2-VASc and CAAP-AF were the only risk scores with predictive value for procedural complications (AUC 0.616, p = 0.043; AUC 0.615, p = 0.044; respectively). ROC curve analyses of the studied risk scores for the prediction of AF recurrence and complications are shown in Figure. Conclusion Currently available risk scores perform poorly in predicting outcomes after RF-PVI. These data suggest that the utility of these scores for clinical decision-making is limited. Abstract Figure. ROC curve analyses of risk scores

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P963Recurrence of atrial fibrillation after cryoballoon pulmonary vein isolation in overweight and obese patients - does weight matter?

EP Europace ◽

10.1093/europace/euaa162.383 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Weinmann ◽

S Gillmeister ◽

D Aktolga ◽

C Bothner ◽

M Rattka ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Normal Weight ◽

Overweight And Obesity ◽

Obese Patients ◽

Baseline Characteristics ◽

One Year ◽

Af Recurrence

Abstract Funding Acknowledgements Karolina Weinmann was supported by the Hertha-Nathorff fellowship from Ulm University Background - Obesity is a known risk factor for the incidence and persistence of atrial fibrillation. Many interventional studies proved losing weight correlates with less atrial fibrillation (AF) burden. Purpose – We investigated the influence of overweight and obesity on baseline characteristics, procedural values and outcome after cryoballoon pulmonary vein isolation (cryoballoon PVI). Methods – We investigated 575 patients undergoing cryoballoon PVI at our Medical Center. 142 patients were classified as normal with a body mass index (BMI) of 18.5 – 24.9 kg/m², 239 patients presented overweight with a BMI of 25.0 – 29.9 kg/m² and 194 patients were obese with a BMI over 30.0. We compared the baseline characteristics, the procedural and outcome data of these patients. Results – Comparing baseline characteristics of overweight and obese patients to normal weight patients, obese show the highest portion in hypertension (obese vs. normal: 86.1% vs. 68.3%, p < 0.001), diabetes (26.8% vs. 14.8%, p < 0.05), OSAS (17.0% vs. 2.1%, p < 0.001) and left atrial (LA) diameter (44.6 ± 10.8mm vs. 41.3 ± 12.7mm, p < 0.05). Comparison of procedure duration, fluoroscopy time and area dose product (Gy*cm²), only the area dose product shows a significantly higher value in the overweight and obese patients (p < 0.001). Moreover, comparing the duration of ablation, time to isolation per pulmonary vein between the three groups, the overweight and obese patients show a significantly longer duration of ablation at the RSPV and the time to isolation is significantly higher at the LSPV. Mean follow-up period in our cohort is 517.3 ± 461.3 days (1.4 ± 1.3 years). Kaplan-Meier estimation shows no significant difference between freedom from AT/AF recurrence comparing normal weight, overweight and obese patients (Log-rank p = 0.6). After one year follow-up, 70% of normal weight patients show freedom from atrial arrhythmia recurrence and 69% of overweight patients. Obese patients have a fraction of 75% of freedom from AT/AF recurrence after one year. Comparing the two years follow-up values 56% of the normal BMI patients, 54% of the overweight patients and 62% of obese patients are free from arrhythmia recurrence. Conclusion – Cryoballoon PVI procedure in obese and overweight patients is a feasible treatment, however the radiation exposure is higher compared to normal weight. Evaluating outcomes, no difference in recurrence of AF was detected between normal, overweight and obese patients after cryoballoon PVI.

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Is There an Association between Epicardial Adipose Tissue and Outcomes after Paroxystic Atrial Fibrillation Catheter Ablation?

Journal of Clinical Medicine ◽

10.3390/jcm10143037 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3037

Author(s):

Néfissa Hammache ◽

Hugo Pegorer-Sfes ◽

Karim Benali ◽

Isabelle Magnin Poull ◽

Arnaud Olivier ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Epicardial Adipose Tissue ◽

University Hospital ◽

One Year ◽

Af Recurrence

Background: In patients undergoing paroxysmal atrial fibrillation (PAF) ablation, pulmonary vein isolation (PVI) alone fails in maintaining sinus rhythm in up to one third of patients after a first catheter ablation. Epicardial adipose tissue (EAT), as an endocrine-active organ, could play a role in the recurrence of AF after catheter ablation. Objective: To evaluate the predictive value of clinical, echocardiographic, biological parameters and epicardial fat density measured by computed tomography scan (CT-scan) on AF recurrence in PAF patients who underwent a first pulmonary vein isolation procedure using radiofrequency (RF). Methods: This monocentric retrospective study included all patients undergoing first-time RF PAF ablation at the Nancy University Hospital between March 2015 and December 2018 with one-year follow-up. Results: 389 patients were included, of whom 128 (32.9%) had AF recurrence at one-year follow-up. Neither total-EAT volume (88.6 ± 37.2 cm3 vs. 91.4 ± 40.5 cm3, p = 0.519), nor total-EAT radiodensity (−98.8 ± 4.1 HU vs. −98.8 ± 3.8 HU, p = 0.892) and left atrium-EAT radiodensity (−93.7 ± 4.3 HU vs. −93.4 ± 6.0 HU, p = 0.556) were significantly associated with AF recurrence after PAF ablation. In multivariate analysis, previous cavo-tricuspid isthmus (CTI) ablation, ablation procedure duration, BNP and triglyceride levels remained independently associated with AF recurrence after catheter ablation at 12-months follow-up. Conclusion: Contrary to persistent AF, EAT parameters are not associated with AF recurrence after paroxysmal AF ablation. Thus, the role of the metabolic atrial substrate in PAF pathophysiology appears less obvious than in persistent AF.

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B-PO02-073 ONE-YEAR FOLLOW-UP AFTER WIDE-AREA PULMONARY VEIN ISOLATION USING THE VISUALLY GUIDED LASER BALLOON FOR ATRIAL FIBRILLATION

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.328 ◽

2021 ◽

Vol 18 (8) ◽

pp. S125-S126

Author(s):

Takashi Yamasaki ◽

Tetsuhisa Hattori Keisuke Ohta ◽

Nobuyuki Miyai, Reo Nakamura ◽

Takayoshi Sawanishi Noriyuki Kinosita ◽

Ken Kakita

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Wide Area ◽

Visually Guided ◽

One Year ◽

Laser Balloon

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Real-time local impedance monitoring to assess tissue lesion during pulmonary vein isolation: a new tool for AF ablation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0562 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Di Cori ◽

L Segreti ◽

G Zucchelli ◽

S Viani ◽

F Tarasco ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Contact Force ◽

Vascular Complications ◽

Lesion Formation ◽

Tissue Impedance ◽

Af Ablation ◽

Group 2 ◽

Group 1

Abstract Background Contact force catheter ablation is the gold standard for treatment of atrial fibrillation (AF). Local tissue impedance (LI) evaluation has been recently studied to evaluate lesion formation during radiofrequency ablation. Purpose Aim of the study was to assess the outcomes of an irrigated catether with LI alghorithm compared to contact force (CF)-sensing catheters in the treatment of symptomatic AF. Methods A prospective, single-center, nonrandomized study was conducted, to compare outcomes between CF-AF ablation (Group 1) and LI-AF ablation (Group 2). For Group 1 ablation was performed using the Carto 3© System with the SmartTouch SF catheter and, as ablation target, an ablation index value of 500 anterior and 400 posterior. For Group 2, ablation was performed using the Rhythmia™ System with novel ablation catheter with a dedicated algorithm (DirectSense) used to measure LI at the distal electrode of this catheter. An absolute impedance drop greater than 20Ω was used at each targeted. According to the Close Protocol, ablation included a point by point pulmonary vein isolation (PVI) with an Inter-lesion space ≤5 mm in both Groups. Procedural endpoint was PVI, with confirmed bidirectional block. Results A total of 116 patients were enrolled, 59 patients in Group 1 (CF) and 57 in Group 2 (LI), 65 (63%) with a paroxismal AF and 36 (37%) with a persistent AF. Baseline patients features were not different between groups (P=ns). LI-Group showed a comparable procedural time (180±89 vs 180±56, P=0.59) but with a longer fluoroscopy time (20±12 vs 13±9 min, P=0.002). Wide antral isolation was more often observed in CF-Group (95% vs 80%, P=0.022), while LI-Group 2 required frequently additional right or left carina ablation (28% vs 14%, P=0.013). The mean LI was 106±14Ω prior to ablation and 92.5±11Ω after ablation (mean LI drop of 13.5±8Ω) during a median RF time of 26 [19–34] sec for each ablation spot. No steam pops or complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated in all study patients. Regarding safety, only minor vascular complications were observed (5%), without differences between groups (p=0.97). During follow up, 9-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 86% in Group 1 and 75% in Group 2 (P=0.2). Conclusions An LI-guided PV ablation strategy seems to be safe and effective, with acute and mid-term outcomes comparable to the current contact force strategy. LI monitoring could be a promising complementary parameter to evaluate not only wall contact but also lesion formation during power delivery. Procedural Outcomes Funding Acknowledgement Type of funding source: None

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Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation

EP Europace ◽

10.1093/europace/euaa383 ◽

2020 ◽

Author(s):

Michelle Lycke ◽

Maria Kyriakopoulou ◽

Milad El Haddad ◽

Jean-Yves Wielandts ◽

Gabriela Hilfiker ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Prospective Trial ◽

High Rate ◽

Binary Logistic Regression Analysis ◽

Ablation Time ◽

Increased Risk ◽

Af Recurrence

Abstract Aims Catheter ablation of paroxysmal atrial fibrillation (AF) reduces AF recurrence, AF burden, and improves quality of life. Data on clinical and procedural predictors of arrhythmia recurrence are scarce and are flawed by the high rate of pulmonary vein reconnection evidenced during repeat procedures after pulmonary vein isolation (PVI). In this study, we identified clinical and procedural predictors for AF recurrence 1 year after CLOSE-guided PVI, as this strategy has been associated with an increased PVI durability. Methods and results Patients with paroxysmal AF, who received CLOSE-guided PVI and who participated in a prospective trial in our centre, were included in this study. Uni- and multivariate models were plotted to find clinical and procedural predictors for AF recurrence within 1 year. Three hundred twenty-five patients with a mean age of 63 years (CHA2DS2VASc 1 [1–3], left atrium diameter 41 ± 6 mm) were included. About 60.9% were male individuals. After 1 year, AF recurrence occurred in 10.5% of patients. In a binary logistic regression analysis, the diagnosis-to-ablation time (DAT) was found to be the strongest predictor of AF recurrence (P = 0.011). Diagnosis-to-ablation time ≥1 year was associated with a nearly two-fold increased risk for developing AF recurrence. Conclusion The DAT is the most important predictor of arrhythmia recurrence in low-risk patients treated with durable pulmonary vein isolation for paroxysmal AF. Whether reducing the DAT could improve long-term outcomes should be investigated in another trial.

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P2846Focal impulse and rotor modulation ablation versus pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation (FIRMAP AF study)

European Heart Journal ◽

10.1093/eurheartj/ehz748.1156 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Tilz ◽

C L Lenz ◽

P S Sommer ◽

N Sawan ◽

R Meyer-Saraei ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Gold Standard ◽

Artery Aneurysm ◽

Rf Ablation ◽

Af Ablation ◽

Number Of Patients

Abstract Background Based on the assumption of trigger elimination, pulmonary vein isolation (PVI) currently presents the gold standard of atrial fibrillation (AF) ablation. Recently, rapidly spinning rotors or focal impulse formation has been raised as a crucial sustaining mechanism of AF. Ablation of these rotors may potentially obviate the need for trigger elimination with PVI. Purpose This study sought to compare the safety and effectiveness of Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation only with the gold standard of pulmonary vein isolation (PVI) in patients with paroxysmal AF. Methods This was a post-market, prospective, single-blinded, randomized, multi-center trial. Patients were enrolled at three centers and equally (1:1) randomized between those undergoing conventional RF ablation with PVI (PVI group) vs. those treated with FIRM-guided RF ablation without PVI (FIRM group). Data was collected at enrollment, procedure, and at 7-day, 3-month, 6-month, and 12-month follow-up visits. The study was closed early by the sponsor. At the time of study closure, any pending follow-up visits were waived. Results From February 2016 until February 2018, a total of 51 (out of a planned 170) patients (mean age 63±10.6 years, 57% male) were enrolled and randomized. Four patients withdrew from the study prior to treatment, resulting in 23 patients allocated to the FIRM group and 24 in the PVI group. Only 13 patients in the FIRM group and 11 patients in the PVI group completed the 12-month follow-up. Statistical analysis was not completed given the small number of patients. Single-procedure effectiveness (freedom from AF/atrial tachycardia recurrence after blanking period) was 52.9% (9/17) in the FIRM group and 85.7% (12/14) in the PVI group at 6 months; and 31.3% (5/16) in the FIRM group and 80% (8/10) in the PVI group at 12 months. Repeat procedures were performed in 45.8% (11/24) patients in the FIRM group and 7.4% (2/27) in the PVI group. The acute safety endpoint [freedom from procedure-related serious adverse events (SAE)] was achieved in 87% (20/23) of FIRM group patients and 100% (24/24) of PVI group patients. Procedure related SAEs occurred in three patients in the FIRM group: 1 femoral artery aneurysm and 2 injection site hematomas. No additional procedure-related SAEs were reported >7 days post-procedure. Conclusions These partial study effectiveness results reinforce the importance of PVI in paroxysmal atrial fibrillation patients and suggest that FIRM-guided ablation alone (without PVI) is not an effective strategy for treatment of paroxysmal AF in most patients. Further study is needed to understand the effectiveness of adding FIRM-guided ablation as an adjunct to PVI in this patient group. Acknowledgement/Funding Abbot

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The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

Cardiology Research and Practice ◽

10.1155/2016/8632509 ◽

2016 ◽

Vol 2016 ◽

pp. 1-13 ◽

Cited By ~ 12

Author(s):

Paolo D. Dallaglio ◽

Timothy R. Betts ◽

Matthew Ginks ◽

Yaver Bashir ◽

Ignasi Anguera ◽

...

Keyword(s):

Atrial Fibrillation ◽

At Risk ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Waiting Time ◽

Critical Review ◽

Recurrence Rates ◽

The Impact ◽

Af Recurrence

The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.

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