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Adenosine-guided pulmonary vein isolation versus conventional pulmonary vein isolation in patients undergoing atrial fibrillation ablation: An updated meta-analysis

Papageorgiou, N; Providencia, R; Srinivasan, N; Bronis, K; Costa, FM; Cavaco, D; Adragao, P; ... Lambiase, PD; + view all (2017) Adenosine-guided pulmonary vein isolation versus conventional pulmonary vein isolation in patients undergoing atrial fibrillation ablation: An updated meta-analysis. International Journal of Cardiology , 227 pp. 151-160. 10.1016/j.ijcard.2016.11.152. Green open access

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Abstract

BACKGROUND: Recurrent atrial fibrillation episodes following pulmonary vein isolation (PVI) are frequently due to reconnection of PVs. Adenosine can unmask dormant conduction, leading to additional ablation to improve AF-free survival. We performed a meta-analysis of the literature to assess the role of adenosine testing in patients undergoing atrial fibrillation (AF) ablation. METHODS: PubMed, EMBASE, and Cochrane databases were searched through until December 2015 for studies reporting on the role of adenosine guided-PVI versus conventional PVI in AF ablation. RESULTS: Eleven studies including 4099 patients undergoing AF ablation were identified to assess the impact of adenosine testing. Mean age of the population was 61 ± 3 years: 25% female, 70% with paroxysmal AF. Follow up period of 12.5 ± 5.1 months. A significant benefit was observed in the studies published before 2013 (OR = 1.75; 95%CI 1.32–2.33, p < 0.001, I2 = 11%), retrospective (OR = 2.05; 95%CI 1.47–2.86, p < 0.001, I2 = 0%) and single-centre studies (OR = 1.58; 95%CI 1.19–2.10, p = 0.002, I2 = 30%). However, analysis of studies published since 2013 (OR = 1.41; 95% CI 0.87–2.29, p = 0.17, I2 = 75%) does not support any benefit from an adenosine-guided strategy. Similar findings were observed by pooling prospective case-control (OR = 1.39; 95%CI 0.93–2.07, p = 0.11, I2 = 75%), and prospective randomized controlled studies (OR = 1.62; 95%CI 0.81–3.24, p = 0.17, I2 = 86%). Part of the observed high heterogeneity can be explained by parameters such as dormant PVs percentage, use of new technology, improvement of center/operator experience, patients' characteristics including gender, age, and AF type. CONCLUSIONS: Pooling of contemporary data from high quality prospective case–control & prospective randomized controlled studies fails to show the benefit of adenosine-guided strategy to improve AF ablation outcomes.

Type: Article
Title: Adenosine-guided pulmonary vein isolation versus conventional pulmonary vein isolation in patients undergoing atrial fibrillation ablation: An updated meta-analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijcard.2016.11.152
Publisher version: http://doi.org/10.1016/j.ijcard.2016.11.152
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Pulmonary veins, Catheter ablation, Arrhythmia, Atrial fibrillation, Adenosine
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/1557348
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