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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAdenosine-guided elimination of dormant pulmonary vein (PV) conduction decreases recurrence of atrial tachyarrhythmias (ATs) in patients undergoing catheter ablation for paroxysmal atrial fibrillation (AF). This article presents data from the Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination trial [ADVICE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01058980\u0026amp;atom=%2Fspmdc%2F14%2F9%2F15.atom\u0022\u003ENCT01058980\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAdenosine-guided elimination of dormant pulmonary vein (PV) conduction decreases recurrence of atrial tachyarrhythmias (ATs) in patients undergoing catheter ablation for paroxysmal atrial fibrillation (AF). Laurent Macle, MD, Montreal Heart Institute, Montreal, Canada, presented data from the Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination trial [ADVICE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01058980\u0026amp;atom=%2Fspmdc%2F14%2F9%2F15.atom\u0022\u003ENCT01058980\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EFollowing catheter ablation, up to 50% of patients experience recurrence of AF, which is often a result of the recovery of PV conduction. The need for additional ablation can be determined with adenosine, as the agent is able to unmask dormant conduction after PV ablation. However, the effect of an adenosine-guided AF ablation strategy on the prevention of arrhythmia recurrence is unknown. The purpose of the ADVICE trial was to evaluate the effect of adenosine-guided ablation on the long-term efficacy of PV isolation in patients with paroxysmal AF.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the multicenter single-blind Phase 4 ADVICE trial, 534 patients undergoing radiofrequency catheter ablation were studied. Following PV isolation, dormant PV conduction was assessed with intravenous adenosine. If dormant conduction was elicited, patients were randomly assigned to no further ablation or to additional adenosine-guided ablation until dormant conduction was abolished. If no dormant conduction was revealed, randomly selected patients were followed in a registry.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary endpoint was time to first recurrence of symptomatic electrocardiogram-documented AT \u226530 seconds between Day 91 and Day 365 following ablation or any repeat ablation procedure. Major secondary endpoints included time to first recurrence of any electrocardiogram-documented AT, antiarrhythmic drug use, repeat ablation for recurrent AT, and major complications.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe median dose of adenosine used for the assessment of dormant PV conduction was 12 mg. Dormant conduction was present in 53% of patients and 21% of PVs. In the additional ablation arm, 95% of patients experienced successful elimination of dormant conduction.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAmong patients with dormant PV conduction, a significantly greater number who received additional targeted ablation achieved event-free survival (freedom from symptomatic AT) compared with patients who received no further ablation (HR, 0.44; 95% CI, 0.31 to 0.64; p\u0026lt;0.0001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Event-free survival occurred in 69.4% of patients with dormant conduction randomly assigned to additional targeted ablation, 55.7% without dormant conduction, and 42.3% with dormant conduction randomly assigned to no further ablation.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/15\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of Additional Targeted Ablation for Dormant Conduction on Atrial Tachyarrhythmia Recurrence\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-807935734\u0022 data-figure-caption=\u0022Effect of Additional Targeted Ablation for Dormant Conduction on Atrial Tachyarrhythmia Recurrence\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/15\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/15\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/15\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15884\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EEffect of Additional Targeted Ablation for Dormant Conduction on Atrial Tachyarrhythmia Recurrence\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from L Macle, MD.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003E*On November 21, 2014, this was changed from Dornmant to Dormant. On November 21, 2014, this was changed from Dormarnt to Dormant.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EIn addition, patients with dormant conduction who were randomly assigned to additional targeted ablation showed greater event-free survival in terms of any AT, with and without the use of antiarrhythmic drugs. Repeat ablation for recurrent AT was required in 35% of patients with dormant conduction who did not receive further ablation, compared with 20.4% of patients who had dormant conduction and received additional targeted ablation and 27.4% patients who did not have dormant conduction. Serious adverse events occurred in 7.2% of patients, and the rate was similar among all study arms.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EIn conclusion, Dr. Macle stated that, in his opinion, the data from the ADVICE trial indicate that elimination of dormant PV conduction represents an important intervention to reduce AT and that adenosine should be routinely used to identify and guide the elimination of dormant conduction during PV isolation in patients with paroxysmal AF.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/9\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp6g1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp6g1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}