Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter

Gustavo Morales, Yousef H. Darrat, Nicolas Lellouche, Sun Moon Kim, Muhammad Butt, Katrina Bidwell, William Lippert, Gbolahan Ogunbayo, David Hamon, Luigi Di Biase, Andrea Natale, Kevin Parrott, Claude S. Elayi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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. Journal compilation

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - 2017
Externally publishedYes

Fingerprint

Atrial Flutter
Adenosine
Catheter Ablation
Documentation
Recurrence

Keywords

  • Adenosine
  • Atrial flutter
  • Catheter ablation
  • Cavitricuspid ablation
  • Reconnection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter. / 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.

In: Journal of Cardiovascular Electrophysiology, 2017.

Research output: Contribution to journalArticle

Morales, G, Darrat, YH, Lellouche, N, Kim, SM, Butt, M, Bidwell, K, Lippert, W, Ogunbayo, G, Hamon, D, Di Biase, L, Natale, A, Parrott, K & Elayi, CS 2017, 'Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.13233
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. / Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter. In: Journal of Cardiovascular Electrophysiology. 2017.
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title = "Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter",
abstract = "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. Journal compilation",
keywords = "Adenosine, Atrial flutter, Catheter ablation, Cavitricuspid ablation, Reconnection",
author = "Gustavo Morales and Darrat, {Yousef H.} and Nicolas Lellouche and Kim, {Sun Moon} and Muhammad Butt and Katrina Bidwell and William Lippert and Gbolahan Ogunbayo and David Hamon and {Di Biase}, Luigi and Andrea Natale and Kevin Parrott and Elayi, {Claude S.}",
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T1 - Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter

AU - Morales, Gustavo

AU - Darrat, Yousef H.

AU - Lellouche, Nicolas

AU - Kim, Sun Moon

AU - Butt, Muhammad

AU - Bidwell, Katrina

AU - Lippert, William

AU - Ogunbayo, Gbolahan

AU - Hamon, David

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Parrott, Kevin

AU - Elayi, Claude S.

PY - 2017

Y1 - 2017

N2 - 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. Journal compilation

AB - 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. Journal compilation

KW - Adenosine

KW - Atrial flutter

KW - Catheter ablation

KW - Cavitricuspid ablation

KW - Reconnection

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DO - 10.1111/jce.13233

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JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

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