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Published on: February 22, 2018
Response to adenosine differentiates focal from macroreentrant atrial tachycardia: validation using three-dimensional
Sei Iwai1, Steven M Markowitz, Kenneth M Stein
1Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, NY 10021, USA.
Adenosine effectively differentiates focal atrial tachycardia (AT) from macroreentrant AT. Focal ATs were terminated or suppressed by adenosine, while macroreentrant ATs were insensitive, aiding procedural strategy.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Adenosine's effect on atrial tachycardia (AT) mechanisms is debated.
- Previous proposals suggested mechanism-specific adenosine effects on AT.
- Clarifying adenosine's role in differentiating AT types is crucial.
Purpose of the Study:
- To determine if adenosine response differentiates focal from macroreentrant AT.
- To utilize 3D electroanatomic mapping to define tachycardia circuits.
- To assess adenosine's utility in guiding ablation strategies.
Main Methods:
- Examined adenosine's effect on 43 ATs in 42 patients.
- Utilized 3D electroanatomic mapping, entrainment, and pharmacological perturbation.
- Characterized ATs as focal (triggered/automatic) or macroreentrant.
Main Results:
- Adenosine terminated or suppressed 33 of 35 focal ATs.
- All 8 macroreentrant ATs were insensitive to adenosine.
- Focal ATs were often located along the crista terminalis or tricuspid annulus.
Conclusions:
- Adenosine response reliably differentiates focal from macroreentrant AT.
- This differentiation can guide focused and strategic ablation.
- Adenosine serves as a valuable tool at the start of procedures.
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