Role of adenosine in atrial fibrillation

Role of adenosine in atrial fibrillation First and foremost, it must be remembered that adenosine is not to be given in atrial fibrillation if there is an atrioventricular bypass tract (ventricular pre-excitation) like Wolff-Parkinson-White syndrome. This is because it slows conduction through the atrioventricular (AV) node, but does not affect the accessory pathway. Secondly, adenosine can rarely induce atrial fibrillation and very rarely ventricular fibrillation. Adenosine guided pulmonary vein ablation has been studied as adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction. Identifying dormant conduction will guide additional ablation to potentially improve the results of catheter ablation of atrial fibrillation. ADVICE (ADenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) trial on this aspect was a randomized study at 18 hospitals across Australia, Europe, and North America [1]. Adenosine was administered intravenously after pulmonary vein isolation in symptomatic paroxysmal atrial fibrillation in which one anti arrhythmic drug had failed. If dormant conduction was identified, patients were randomized to additional adenosine guided ablation to abolish dormant conduction or to no further ablation. Patients were masked to treatment allocation. Those in whom no dormant conduction was revealed, randomly selected patients were included in  a registry. Primary outcome measure was symptomatic atr...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs