Impact And Significance Of Adenosine Triphosphate On Recovered Left Atrium-Pulmonary Veins Conduction After Circumferential Pulmonary Vein Isolation For Atrial Fibrillation

【Objective】Circumferential pulmonary vein isolation technique (CPVI) is a cornerstone of catheter ablation for atrial fibrillation. Problem is higher recurrence rate at this stage . The aim of this study was to seek to means of reducing recurrence after CPVI by reablating adenosine triphosphate (ATP)-induced "acute" left atrium - pulmonary vein potential conduction gap (Gap) and to provide a simple, effective and feasible method to clinical work.【Methods】Between November 2009 and October 2010, one hundred and eight atrial fibrillation patients after catheter ablation [69men, 39 women; mean age (57.61±10.67) years, range 32~77years] were included in this study.at the Xiamen range from 14days to 15years. Of these cases,75cases with paroxysmal AF and 33 cases with persistent AF underwent catheter ablation. The control group was 83 cases atrial fibrillation patients after catheter ablation at the Xiamen Heart Center from January 2009 to October2009. There were no significant differences in age, sex, duration of atrial fibrillation, paroxysmal atrial fibrillation / persistent atrial fibrillation, hypertension prevalence, the prevalence of structural heart disease, left ventricular ejection fraction (EF value), left atrium diameter and follow-up time.between experimental group and control group.30minutes after CPVI had been completed, Isoproterenol and ATP were injected to induced''dormant''pulmonary vein conduction recovery. If pulmonary vein conduction was recoverable and continued, we sought gaps of circumferential pulmonary vein ablation line and reablated until seconed isolation We continued to observe for 30 minutes, repeated the above and ATP of administration.and additional ablation ..We observed the distribution of Gap areas and followed-up recurrence rate of long-term. 【Results】46 patients (42.6%) "spontaneous " pulmonary vein conduction recovery and 97 (22.7%)of 428 pulmonary veins potential recovery were observed in 30 minutes after CPVI. ATP-reconnection was present in 48(44.4%)patients, occurring in 104(24.3%) pulmonary veins: 36(34.6%)in the LSPV and left common trunk, 17(16.3%) in the LIPV, 31(29.8) in the RSPV and right common trunk and 20(19.2%)in theRIPV. ATP-reconnection in 4 PVs was seen in 2(1.9%)patients.77gaps were most commonly situated at the left pulmonary veins anterior segment and right pulmonary veins posterior segment. Long-term recurrence rate of experimental group patients was lower than control group (19.4% vs28.9%, P = 0.03).【Conclusion】1.Recovery of pulmonary vein conduction is a common after CPVI. "spontaneous"recovery of pulmonary vein conduction was present 42.6% of the patients and 22.7% of the pulmonary veins in 30 minutes after CPVI.2.Recovery of left atrial - pulmonary vein conduction is the main mechanism of recurrence of atrial fibrillation after CPVI.3.ATP-induced gaps were most commonly situated at the left pulmonary veins anterior segment and right pulmonary veins postero segment, which may relate to unsatisfactory catheter postion,the complexity of local anatomy andthick,myocardial and selection.of the ablation line.4.Additional ablation to ATP-induced pulmonary vein conduction gaps can reduce long-term recurrence rate of atrial fibrillation catheter ablation5.Isoproterenol may lengthen the time of ATP-reconnection but does not create the ATP-reconnection itself.6.ATP may induce recovery of left atrium-pulmonary vein conduction through receptor mechanisms and neural mechanisms.