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Heart Lung Circ. 2018 May;27(5):601-610. doi: 10.1016/j.hlc.2017.04.020. Epub 2017 Jun 7.

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

Author information

1
Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia. Electronic address: nwan5905@uni.sydney.edu.au.
2
Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia.
3
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
4
Department of Cardiology, Paras HMRI Hospitals, Raja Bazar, Patna, India​.

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.

KEYWORDS:

Ablation; Adenosine; Atrial fibrillation

PMID:
28655535
DOI:
10.1016/j.hlc.2017.04.020
[Indexed for MEDLINE]

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