What question did this study set out to answer?

To evaluate the impact of routine adenosine administration to unmask dormant pulmonary vein conduction and guide ablation on clinical outcomes following pulmonary vein isolation.

February 22, 2013Journal of Cardiovascular Electrophysiology

The Role of Adenosine Following Pulmonary Vein Isolation in Patients Undergoing Catheter Ablation for Atrial Fibrillation: A Systematic Review

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Why the study?

Does routine adenosine testing following pulmonary vein isolation improve freedom from atrial fibrillation in patients undergoing catheter ablation?

Key Points

To evaluate the impact of routine adenosine administration to unmask dormant pulmonary vein conduction and guide ablation on clinical outcomes following pulmonary vein isolation.
Systematically searched electronic databases through July 31, 2012, for studies evaluating adenosine testing and ablation outcomes after pulmonary vein isolation for atrial fibrillation.
Identified 6 studies (N=544) assessing targeted ablation of adenosine-induced reconnection and 3 studies (N=612) evaluating the impact of adenosine testing on arrhythmia recurrence.
Synthesized relative risks using random-effects meta-analysis models.
Routine adenosine testing for pulmonary vein reconnection coupled with targeted ablation significantly improved freedom from atrial fibrillation post-procedure (RR 1.25; 95% CI 1.12–1.40; P < 0.001).
Among patients undergoing adenosine testing, acute reconnection showed a non-significant trend toward lower freedom from atrial fibrillation despite additional ablation (RR 0.91; 95% CI 0.81–1.03; P = 0.15).

Structured PICO

Does routine adenosine testing following pulmonary vein isolation improve freedom from atrial fibrillation in patients undergoing catheter ablation?

Population

1,156 patients undergoing catheter ablation (pulmonary vein isolation) for symptomatic atrial fibrillation across 9 studies (6 studies with 544 patients assessing targeted ablation for adenosine-induced PV reconnection, and 3 studies with 612 patients assessing the impact of adenosine testing).

Intervention

Routine adenosine administration/testing following pulmonary vein isolation to unmask dormant PV conduction, with additional targeted ablation if reconnection occurs.

Comparator

Standard pulmonary vein isolation without routine adenosine testing.

Outcome

Freedom from atrial fibrillation post-PVI.hard clinical

Routine adenosine testing after pulmonary vein isolation improves freedom from atrial fibrillation, supporting its use to identify and ablate dormant conduction.

Discussion

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Implication

Supports routine adenosine testing post-PVI; confirms benefit of targeting dormant reconnection in meta-analysis.

Cite This Study

McLellan et al. (2013) studied this question.

synapsesocial.com/papers/6a71468ffe4101aa97e08141 https://doi.org/10.1111/jce.12121

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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The Role of Adenosine Following Pulmonary Vein Isolation in Patients Undergoing Catheter Ablation for Atrial Fibrillation: A Systematic Review

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

The Role of Adenosine Following Pulmonary Vein Isolation in Patients Undergoing Catheter Ablation for Atrial Fibrillation: A Systematic Review

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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