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

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±3years: 25% female, 70% with paroxysmal AF. Follow up period of 12.5±5.1months. 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.