Adenosine Testing After Atrial Fibrillation Ablation: Systematic Review and Meta-Analysis.

Abstract

BACKGROUND:

Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). We performed a systematic review and meta-analysis to assess the impact of adenosine administration in patients undergoing PVI for AF.

METHODS:

Meta-analysis of 22 studies was performed to assess the rates of freedom from AF in 1) patients with dormant PV conduction versus patients without dormant PV conduction, and 2) patients given routine adenosine post PVI versus patients not given adenosine. Relative-risks (RR) were calculated using random effects modelling.

RESULTS:

In 18 studies, 3038 patients received adenosine and freedom from AF in those patients with dormant PV reconnection was significantly lower (62.9%) compared to patients without PV reconnection (67.2%) (RR 0.87; 95% CI: 0.78-0.98). In seven studies with 3049 patients, the freedom from AF was significantly higher in patients who received adenosine (67%) versus those patients who did not receive adenosine (63%) (RR: 1.11; 95% CI: 1.01-1.22).

CONCLUSIONS:

The present study showed clear benefits of adenosine testing for freedom from AF recurrence. Adenosine-guided dormant conduction is associated with higher AF recurrence despite further ablation. Future studies should investigate the optimal methodology, including dosage and waiting time between PVI and adenosine administration.

• Authors: Nelson Wang, Steven Phan, Aran Kanagaratnam, Narendra Kumar, Kevin Phan
• Journal: Heart, lung & circulation (Heart Lung Circ) Vol. 27 Issue 5 Pg. 601-610 (May 2018) ISSN: 1444-2892 [Electronic] Australia
• PMID: 28655535 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Chemical References

• Vasodilator Agents
• Adenosine

Topics

• Adenosine (pharmacology)
• Atrial Fibrillation (diagnosis, physiopathology, surgery)
• Catheter Ablation
• Heart Conduction System (drug effects, physiopathology)
• Heart Rate (drug effects)
• Humans
• Postoperative Period
• Vasodilator Agents (pharmacology)