Premium
Pace capture and adenosine triphosphate provocation are complementary rather than mutually exclusive methods to ensure durable pulmonary vein isolation
Author(s) -
Zeng LiJun,
Shi Liang,
Tian Ying,
Wang YanJiang,
Yin XianDong,
Liu XiaoQing,
Yang XinChun,
Liu XingPeng
Publication year - 2019
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.13901
Subject(s) - medicine , provocation test , ablation , pulmonary vein , adenosine triphosphate , atrial fibrillation , cardiology , catheter ablation , anesthesia , pathology , alternative medicine
Adenosine triphosphate (ATP)‐provoked dormant conduction (DC) and pacing for unexcitability are used to identify conduction gaps along the ablation lines after circumferential pulmonary vein isolation (CPVI). We aim to determine whether ATP provocation and pacing are interchangeable as endpoints for ablation of paroxysmal atrial fibrillation (PAF). Methods and Results A total of 107 patients with PAF were randomly divided into two groups after completion of CPVI. In group I (A‐P group, n = 53), ATP was administered first. If DC was uncovered, additional ablation was performed until ATP tests were negative. Bipolar pacing along the ablation line was performed subsequently. In group II (P‐A group, n = 54), the same protocol was used, but the pacing and the ATP tests were performed in the opposite sequence. The 12‐month ablation outcomes of all patients were compared with those of a historical control group of 107 patients with PAF in whom only ATP test was performed. Regardless of which test was performed first, the other modality still identified conduction gaps. In group I, pacing maneuvers identified gaps in 49% ( n = 26) of patients who had negative ATP tests. In group II, ATP tests uncovered DC in 18.5% ( n = 10) of patients in whom pacing identified no gaps. After 12 months, a higher proportion of patients (91.6%) were free from atrial tachyarrhythmias compared with the historical control group (81.3%; P = 0.031). Conclusion Pacing along the ablation lines and ATP provocation are complementary tests for evaluating the durability of CPVI and can lead to better long‐term outcomes when used in combination.