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Adenosine sensitivity is associated with ablation success rate and recurrence rate with nonirrigated catheters in patients with ventricular premature contractions/tachycardia from the ventricular outflow tract.

Feng XF, Wang QS, Sun J, Zhang R, Zhang PP, Wang J, Feng DL, Li YG - Chin. Med. J. (2015)

Bottom Line: According to adenosine test, all patients were divided into a sensitive group (S group) or an insensitive group (I group).The patients of each group were randomized into a nonirrigated catheter (NA) subgroup or an irrigated catheter (IA) subgroup with a 2:1 ratio.Adenosine insensitivity is associated with a lower success rate and a higher recurrence rate for VA patients undergoing nonirrigated catheter ablation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.

ABSTRACT

Background: A high ablation success rate for ventricular arrhythmia (VA) from outflow tract has been achieved, but some of them cannot be eliminated from endocardium. We investigated the association between adenosine sensitivity and ablation success/recurrence rates with a nonirrigated or an irrigated catheter.

Methods: According to adenosine test, all patients were divided into a sensitive group (S group) or an insensitive group (I group). The patients of each group were randomized into a nonirrigated catheter (NA) subgroup or an irrigated catheter (IA) subgroup with a 2:1 ratio.

Results: In S group of 122 patients (84 in NA subgroup), the ablation success rate was similar between two subgroups (94.7% vs. 90.5%, P > 0.05), but in I group of 94 patients (60 in NA subgroup), it was higher in IA subgroup (94.1%) than that in NA subgroup (73.3%, P < 0.05). The success rate using nonirrigated catheter was significantly higher in S group (90.5%) than that in I group (73.3%, P < 0.01), and the recurrence rate was lower in S group than that in I group (1.3%, vs. 13.6%, P < 0.05). On the contrary, the success rate and the recurrence rate using irrigated catheter were similar between S group and I group (94.7%, 94.1%, P > 0.05, vs. 2.8%, 6.3%, P > 0.05).

Conclusions: Adenosine insensitivity is associated with a lower success rate and a higher recurrence rate for VA patients undergoing nonirrigated catheter ablation. Thus, irrigated catheters should be the first choice for VA ablation in adenosine insensitive patients.

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Related in: MedlinePlus

A representative case of adenosine insensitive response of premature ventricular contractions (PVCs). PVCs were not suppressed completely with development of A-V Block/Brady arrhythmias during the adenosine action interval.
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Figure 2: A representative case of adenosine insensitive response of premature ventricular contractions (PVCs). PVCs were not suppressed completely with development of A-V Block/Brady arrhythmias during the adenosine action interval.

Mentions: During EPS, adenosine was administered as a bolus (18 mg)[7] via a peripheral vein during frequent PVCs or short-burst VT. Adenosine action was defined as suppression or termination of VA, sinus node suppression, or atrial-ventricular block occurring within 60 s of adenosine administration. The starting-point of adenosine action was defined as the time at P-R or R-R interval prolongation by 30% or more above baseline level and the end-point was defined as the time when the P-R or R-R interval decreased by 30% or more of baseline level. Adenosine action interval was calculated as the difference between the starting-point time and the end-point time. The time interval between adenosine infusion and the starting-point of adenosine action was defined as the adenosine onset time. The response of the arrhythmia to adenosine was defined as follows: Adenosine sensitive when VT, which had persisted for at least 1 min before adenosine injection was terminated within 30 s of administration of adenosine[15] or there were no PVCs or short-burst VTs of same morphology as spontaneous VA during the adenosine action interval [Figure 1]; adenosine insensitive when VT was not terminated or PVCs were not abolished during the adenosine action interval [Figure 2].


Adenosine sensitivity is associated with ablation success rate and recurrence rate with nonirrigated catheters in patients with ventricular premature contractions/tachycardia from the ventricular outflow tract.

Feng XF, Wang QS, Sun J, Zhang R, Zhang PP, Wang J, Feng DL, Li YG - Chin. Med. J. (2015)

A representative case of adenosine insensitive response of premature ventricular contractions (PVCs). PVCs were not suppressed completely with development of A-V Block/Brady arrhythmias during the adenosine action interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837830&req=5

Figure 2: A representative case of adenosine insensitive response of premature ventricular contractions (PVCs). PVCs were not suppressed completely with development of A-V Block/Brady arrhythmias during the adenosine action interval.
Mentions: During EPS, adenosine was administered as a bolus (18 mg)[7] via a peripheral vein during frequent PVCs or short-burst VT. Adenosine action was defined as suppression or termination of VA, sinus node suppression, or atrial-ventricular block occurring within 60 s of adenosine administration. The starting-point of adenosine action was defined as the time at P-R or R-R interval prolongation by 30% or more above baseline level and the end-point was defined as the time when the P-R or R-R interval decreased by 30% or more of baseline level. Adenosine action interval was calculated as the difference between the starting-point time and the end-point time. The time interval between adenosine infusion and the starting-point of adenosine action was defined as the adenosine onset time. The response of the arrhythmia to adenosine was defined as follows: Adenosine sensitive when VT, which had persisted for at least 1 min before adenosine injection was terminated within 30 s of administration of adenosine[15] or there were no PVCs or short-burst VTs of same morphology as spontaneous VA during the adenosine action interval [Figure 1]; adenosine insensitive when VT was not terminated or PVCs were not abolished during the adenosine action interval [Figure 2].

Bottom Line: According to adenosine test, all patients were divided into a sensitive group (S group) or an insensitive group (I group).The patients of each group were randomized into a nonirrigated catheter (NA) subgroup or an irrigated catheter (IA) subgroup with a 2:1 ratio.Adenosine insensitivity is associated with a lower success rate and a higher recurrence rate for VA patients undergoing nonirrigated catheter ablation.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.

ABSTRACT

Background: A high ablation success rate for ventricular arrhythmia (VA) from outflow tract has been achieved, but some of them cannot be eliminated from endocardium. We investigated the association between adenosine sensitivity and ablation success/recurrence rates with a nonirrigated or an irrigated catheter.

Methods: According to adenosine test, all patients were divided into a sensitive group (S group) or an insensitive group (I group). The patients of each group were randomized into a nonirrigated catheter (NA) subgroup or an irrigated catheter (IA) subgroup with a 2:1 ratio.

Results: In S group of 122 patients (84 in NA subgroup), the ablation success rate was similar between two subgroups (94.7% vs. 90.5%, P > 0.05), but in I group of 94 patients (60 in NA subgroup), it was higher in IA subgroup (94.1%) than that in NA subgroup (73.3%, P < 0.05). The success rate using nonirrigated catheter was significantly higher in S group (90.5%) than that in I group (73.3%, P < 0.01), and the recurrence rate was lower in S group than that in I group (1.3%, vs. 13.6%, P < 0.05). On the contrary, the success rate and the recurrence rate using irrigated catheter were similar between S group and I group (94.7%, 94.1%, P > 0.05, vs. 2.8%, 6.3%, P > 0.05).

Conclusions: Adenosine insensitivity is associated with a lower success rate and a higher recurrence rate for VA patients undergoing nonirrigated catheter ablation. Thus, irrigated catheters should be the first choice for VA ablation in adenosine insensitive patients.

Show MeSH
Related in: MedlinePlus