Key result
ATP-guided additional ablation to eliminate adenosine-induced pulmonary vein reconnection failed to reduce atrial fibrillation recurrence in randomized studies (OR 0.76; 95% CI 0.42-1.40).
Why the study?
Does adenosine/ATP-guided additional ablation reduce atrial fibrillation recurrence in patients undergoing pulmonary vein isolation for atrial fibrillation?
Meta-Analysis (n=3,524)
Does adenosine/ATP-guided additional ablation reduce atrial fibrillation recurrence in patients undergoing pulmonary vein isolation for atrial fibrillation?
Adenosine-guided additional ablation after pulmonary vein isolation does not significantly reduce atrial fibrillation recurrence based on randomized data, but significantly increases procedure time.
AIMS: Atrial fibrillation recurrences after pulmonary vein isolation (PVI) are not uncommon and are frequently related to pulmonary vein reconnection. Adenosine/ATP can reveal dormant pulmonary vein conduction after PVI. Previous studies revealed that adenosine-guided Additional ablation could improve arrhythmia-free survival. We performed a meta-analysis to assess the impact of additional ablation to eliminate adenosine-induced transient pulmonary vein reconnection in terms of atrial fibrillation recurrence at follow-up. METHODS: MEDLINE/PubMed, Cochrane Library and references reporting atrial fibrillation ablation and adenosine/ATP-following PVI were screened, and studies were included if they matched inclusion and exclusion criteria. RESULTS: A total of 3524 patients were enrolled with a median follow-up of 13 (6-20) months. Overall, 70% (60-85) of patients in ATP-guided ablation vs. 63% (48-79) in no ATP-guided ablation were free of atrial fibrillation at follow-up. Pooled results revealed that ATP-guided ablation reduced the risk of atrial fibrillation recurrence of 42% [odds ratio (OR) 0.58, 0.41-0.81], but this result was primary because of the contribution of retrospective over-randomized studies [OR 0.48 (0.35-0.65) vs. 0.76 (0.42-1.40), respectively]. 3.2% of patients experienced an adverse event. ATP-guided ablation is related to a nonsignificant increase in fluoroscopy time (OR 1.71, 0.98-2.96) and to a significant increase in procedure time (OR 2.84, 1.32-6.09). CONCLUSION: Additional ablation aiming to eliminate adenosine-induced transient pulmonary vein reconnection failed to reduce the risk of atrial fibrillation recurrence at follow-up. Moreover, although adenosine-guided PVI is not affected by an augmented risk of adverse events, it is associated with a NS increased fluoroscopy exposure and significantly longer procedure duration. Further studies are required to identify the actual role of adenosine in PVI.
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Blandino et al. (2016) conducted a meta-analysis in Atrial fibrillation (n=3,524). ATP-guided additional ablation vs. No ATP-guided ablation was evaluated on Freedom from atrial fibrillation (OR 0.58, 95% CI 0.41-0.81). ATP-guided additional ablation to eliminate adenosine-induced pulmonary vein reconnection failed to reduce atrial fibrillation recurrence in randomized studies (OR 0.76; 95% CI 0.42-1.40).
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