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Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus‐dependent atrial flutter
Author(s) -
Morales Gustavo,
Darrat Yousef H.,
Lellouche Nicolas,
Kim Sun Moon,
Butt Muhammad,
Bidwell Katrina,
Lippert William,
Ogunbayo Gbolahan,
Hamon David,
Di Biase Luigi,
Natale Andrea,
Parrott Kevin,
Elayi Claude S
Publication year - 2017
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13233
Subject(s) - medicine , ablation , atrial flutter , adenosine , cardiology , catheter ablation , thermal conduction , anesthesia , materials science , composite material
Background Dormant conduction unmasked by adenosine predicts clinical recurrences of cavotricuspid isthmus (CTI) dependent atrial flutter following catheter ablation. Conventional practice involves a waiting period of 20 to 30 minutes after achievement of a bidirectional line of block (BDB) to monitor for recovery of conduction. Objective Assess whether abolition of dormant conduction with adenosine immediately after CTI ablation and BDB can predict the lack of CTI conduction recovery during the following 30 minutes. Methods Consecutive patients undergoing catheter ablation for CTI‐dependent atrial flutter were studied. Following the completion of CTI ablation and documentation of BDB, adenosine (≥12 mg IV) was administered immediately. In cases of dormant conduction, the CTI was ablated again until its abolition. After the achievement of BDB without dormant conduction, spontaneous CTI reconnection during the following 30 minutes and dormant conduction with adenosine at 30 minutes were evaluated. Results A CTI block was achieved in 171 patients. Nine patients (5.3%) had dormant conduction across the CTI immediately after ablation and BDB, and required further ablation. Two patients (1.2%) had subsequent spontaneous time‐dependent reconnection within 30 minutes. Two other patients (1.2%) developed late dormant conduction with adenosine at 30 minutes. All 4 patients underwent further ablation. Conclusion A negative adenosine challenge immediately after CTI ablation with bidirectional block, or after abolition of dormant conduction with further ablation, strongly predicted the absence of subsequent spontaneous reconnection within 30 minutes. Based on these results, the conventional waiting period is unnecessary in 97.6% patients without dormant conduction after CTI‐dependent flutter ablation.