Adenosine plasma level in patients with paroxysmal or persistent atrial fibrillation and normal heart during ablation procedure and/or cardioversion

• DOI: 10.1007/s11302-018-9636-1
• Publication Date: 2018-12-07T17:31:01Z
• Authors: Baptiste Maille; Marion Marlinge; Donato Vairo; Giovanna Mottola; Linda Koutbi; Pierre Deharo; Marguerite Gastaldi; Marine Gaudry; Claire Guiol; Sara Bottone; Patrick Mace; Rosita Gueant; Mohamed Chefrour; Elsa Martinez; Pierre Michelet; Jean Louis Gueant; Alain Boussuges; Jean Ruf; Emmanuel Fenouillet; Jean Claude Deharo; Régis Guieu; Frederic Franceschi
• Keywords: Male; [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology; Adenosine; [SDV]Life Sciences [q-bio]; Electric Countershock; Middle Aged; Atrial fibrillation; Ablation procedure; [SDV] Life Sciences [q-bio]; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Atrial Fibrillation; Catheter Ablation; Humans; Female; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology; Aged

The mechanism of atrial fibrillation (AF) in patients with normal heart remains unclear. While exogenous adenosine can trigger AF, nothing is known about the behavior of endogenous adenosine plasma level (APL) at the onset of AF and during ablation procedure. Ninety-one patients (68 with paroxysmal AF: 40 males, 66 ± 16 years; 23 with persistent AF: 14 males, 69 ± 11 years) and 18 controls were included. Among paroxysmal patients: i) medical therapy alone was performed in 45 cases and ablation procedure in 23. AF was spontaneously resolutive in 6 cases; ii) 23 underwent ablation procedure and blood was collected simultaneously in a brachial vein and in the left atrium; 17 were spontaneously in sinus rhythm while 6 were in sinus rhythm after direct current cardioversion. Among persistent patients: i) in 17 patients, blood samples were collected in a brachial vein before and after direct current cardioversion; ii) in 6 patients, blood samples were collected simultaneously in a brachial vein and in left atrium before and after cardioversion during ablation procedure. CV-APL was higher in patients with persistent AF vs patients with paroxysmal AF (median [range]: 0.9[0.6-1.1] vs 0.7[0.4-1.1] μM; p < 0.001). In patients with paroxysmal AF, LA-APL increased during the AF episode (0.95[0.85-1.4] vs 2.7[1.5-7] μM; p = 0.03) and normalized in sinus rhythm after DCCV. In patients with persistent AF, LA-APL was higher than CV-APL (1.2[0.7-1.8] vs 0.9[0.6-1.1] μM; p < 0.001), and both normalized in sinus rhythm (CV-APL: 0.8[0.6-1.1] vs 0.75[0.4-1] μM; p = 0.03), (LA-APL: 1.95[1.3-3] vs 1[0.5-1.15] μM; p = 0.03). The occurrence of AF is associated with a strong increase of APL in the atrium. The cause of this increase needs further investigations.