Key result
Adenosine testing after CPVI shows no benefit over no testing for preventing recurrent AF.
Why the study?
Whether the adenosine test to unmask dormant conduction after CPVI improves the long-term success rate in patients with AF remains controversial.
Does the adenosine test after CPVI improve the long-term successful rate in patients with atrial fibrillation?
Meta-Analysis (n=5,169)
Does the adenosine test after CPVI improve the long-term successful rate in patients with atrial fibrillation?
The routine use of adenosine testing to unmask and eliminate dormant conduction after pulmonary vein isolation does not appear to improve long-term success rates in patients with atrial fibrillation.
Purpose Circumferential pulmonary vein isolation (CPVI) is a routine ablation strategy of atrial fibrillation (AF). The adenosine test can be used to unmask dormant conduction (DC) of pulmonary veins after CPVI, thereby demonstrating possible pulmonary vein re-connection and the need for further ablation. However, whether adenosine test could help improve the long term successful rate of CPVI is still controversial. This systemic review and meta-analysis was to determine the clinical utility of the adenosine test. Methods PubMed, EMBASE, Web of Science and Cochrane Library database were searched through July 2016 to identify relevant studies using the keywords “dormant pulmonary vein conduction”, “adenosine test”, “circumferential pulmonary vein isolation” and “atrial fibrillation”. A random-effects model was used to compare pooled outcomes and tested for heterogeneity. Results A total of 17 studies including 5169 participants were included in the final meta-analysis. Two groups of comparisons were classified: (1) Long-term successful rate in those AF patients underwent CPVI with and without adenosine test [Group A (+) and Group A (-)]; (2) Long-term successful rate in those patients who had adenosine test with and without dormant conduction [Group DC (+) and Group DC (-)]. The overall meta-analysis showed that no significant difference can be observed between Group A (+) and Group A (-) (RR 1.08; 95% CI 0.97-1.19; P 0.16; I2 66%) and between Group DC (+) and Group DC (-) (RR 1.01; 95% CI 0.91-1.12; P 0.88; I2 60%). Conclusion Pooled meta-analysis suggested adenosine test may not improve long-term successful rate in AF patients underwent CPVI. Furthermore, AF recurrence may not be decreased by eliminating DC provoked by adenosine, even though adenosine test was applied after CPVI. Keywords Atrial fibrillation. Pulmonary vein isolation. Adenosine. Dormant conduction. Meta-analysis
No takes yet. Share an insight, caveat, or question.
Chen et al. (2019) conducted a meta-analysis in Atrial fibrillation (n=5,169). Adenosine test vs. No adenosine test was evaluated on Long-term freedom from recurrent atrial fibrillation (RR 1.08, 95% CI 0.97-1.19, p=0.16). Adenosine testing to unmask dormant conduction after circumferential pulmonary vein isolation did not significantly improve long-term freedom from recurrent atrial fibrillation compared to no adenosine testing (RR 1.08).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: