2.3. Adenosine Testing

First, adenosine was administered at 9 or 12 mg and titrated until at least one P wave was blocked or until there was a sinus pause of 3 s or more. Adenosine administration resulted in unmasking of dormant conduction or AIAF between the PV and the LA. Dormant conduction was defined as transient representation of the PV potential recorded on a circumferential PV catheter. AIAF was defined as AF induced after the P wave was blocked or paused after adenosine administration. Adenosine testing was performed until all the PVs demonstrated complete PVI. PVs with dormant conduction were considered reconnected, and further ablation was performed in all cases with dormant conduction. Repeated adenosine administrations were performed to determine the trigger site of earliest activation in the CS and RA electrograms and to confirm the trigger sites by repositioning the circular mapping catheter. The triggered site of earliest activation was eliminated until AIAF did not occur. For cases where the vein of Marshall (VOM) was identified to be the trigger, a perimitral isthmus ablation was performed.