Early adenosine dose after ablation may help predict accessory pathway conduction
An IV bolus of adenosine administered 10 minutes after radiofrequency ablation of the accessory pathway has the same diagnostic accuracy as waiting 30 minutes for predicting the resumption of pathway conduction, researchers reported.
“[Adenosine] is given after catheter ablation to unmask dormant accessory pathway conduction by slowing atrioventricular conduction and causing membrane hyperpolarization,” John Roshan Jacob, MBBS, MD, DM, CEPS, CCDS, professor in the department of cardiology at Christian Medical College in Vellore, Tamilnadu, India, and colleagues wrote in the study background. “Timing of adenosine administration post-ablation varies in different studies from 15 to 30 minutes. We hypothesized that administration of intravenous adenosine at 10 minutes after ablation would have the same diagnostic accuracy as waiting for 30 minutes in predicting the resumption of accessory pathway conduction. The waiting period and the total procedure time could be abbreviated if this was true.”
For the Early Dose of Adenosine Postradiofrequency Ablation of Accessory Pathway (EARLY) study, Jacob and colleagues analyzed data from 110 radiofrequency accessory pathway ablation procedures among 109 adults at two tertiary care centers (mean age, 39 years; 57.8% men). After ablation of the accessory pathway, participants received IV adenosine at 10 minutes to allow researchers to look for dormant pathway conduction. Researchers recorded the response as positive (presence of pathway conduction), negative (absence) or indeterminate.
The findings were published in the Journal of Cardiovascular Electrophysiology.
Adenosine administration at 10 minutes showed a positive result in three cases (2.7%), negative result in 99 cases (90%) and indeterminate result in eight cases (7.3%).
Researchers observed that reconnection of accessory pathway at 30 minutes after ablation was seen in 7.3% of cases. Of those, adenosine administration at 10 minutes after ablation showed a positive test in three patients and negative test in five patients.
The sensitivity, specificity, positive predictive value and negative predictive value of an adenosine test at 10 minutes were 37.5%, 100%, 100% and 94.9%, respectively, in identifying the recurrence of accessory pathway conduction at 30 minutes.
“We found that adenosine testing at 10 minutes had a low sensitivity of 37.5% and a negative predictive value of 94.9%. Hence, it does not appear to be reliable enough to allow an abbreviation of the waiting period,” the researchers wrote. “On the other hand, 10 minutes adenosine testing had a specificity of 100% and positive predictive value of 100%. Hence, 10 minutes adenosine testing may help in early identification of pathway conduction recurrence.”
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