Abstract 11562: Role of Adenosine to Predict Acute and Late Reconnection in Left Atrial Appendage Isolation

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A11562
• Main Authors: Gianni, Carola, Chen, Qiong, Gedikli, Ömer, MacDonald, Bryan C, Della Rocca, Domenico G, Trivedi, Chintan, Mohanty, Sanghamitra, Al-Ahmad, Amin, Burkhardt, J D, Gallinghouse, G J, Hranitzky, Patrick M, Horton, Rodney P, Sanchez, Javier E, Di Biase, Luigi, Natale, Andrea, Elayi, Claude S
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06.11.2018
• ISSN: 0009-7322; 1524-4539

BackgroundAdenosine (ADN) is commonly used to detect dormant pulmonary vein conduction following PVI. It is unclear whether ADN has a similar effect after LAA isolation.Methods50 patients were included in the study. LAA isolation (LAAi) was performed using RF energy delivered by an open-irrigated ablation catheter with a power of 40-45 W. After LAAi, patients received ADN (15 to 27 mg). In 34/50 patients, high-dose isoproterenol (IPN - 20-30 μg/min for 10-15’) was given after and served as a control; in 3 additional patients, spontaneous LAA reconnection (LAAr) occurred by the end of the case and was considered as control (time). The rate of LAAr at follow-up was assessed in those who underwent a repeat ablation (N=13) or TEE (N=18), including assessment of LAA function.Results26% were female, with a mean age of 65±8 years. 42% had PAF, 52% PrAF, 6% LSPAF. The ablation procedure was a redo in 80%. ADN elicited LAAr in 12/50 (24%) patients, 11 of whom had transient recovery. Following IPN, LAA reconnection occurred in 9/34 (27%) patients, 1 of whom had transient recovery. When comparing the effect of ADN vs IPN/time, acute LAAr was overall observed in 12/37 (32%) patients. Out of 12 reconnected LAA, 5 were recognized both by ADN and IPN/time, whereas the remaining 7 were found being reconnected only with IPN/time. The LAAr detection rate of ADN was lower than that of IPN/time (14% vs 32%, McNemar’s P=0.02), with a moderate strength of agreement between the two tests (Kappa=0.5, 95% CI 0.2-0.8). In those who underwent repeat AF ablation, after a mean follow-up of 9±5 months, late LAAr was present in 8/13 patients, 3 of which were positive to ADN in the initial ablation, whereas all 5 electrically isolated LAA were ADN negative, resulting in a PPV of 100% and a NPV of 50%. When excluding those in which LAA was reisolated after the ADN challenge, the PPV remained 100%, with a NPV of 67%. When including patients with TEE at follow-up, after a mean 9±4 months, LAAr was evident in 12/31 patients, 5 of which were positive to ADN in the initial ablation, whereas of the 19 electrically isolated LAA, 16 were ADN negative, resulting in a PPV of 63% and NPV of 79%. The PPV increased to 75% when including only those in which the LAA was left unablated.ConclusionADN identified acute LAAr in 24% of patients following successful LAAi, with a moderate correlation when compared to IPN/time. ADN-mediated acute LAAr was able to predict late LAAr at follow-up with adequate accuracy and therefore can be considered as an alternative to IPN at the time of the initial ablation.