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

Authors

  • ALEX J.A. MCLELLAN M.B.B.S.,

    1. Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
    2. Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
    3. Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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  • SAURABH KUMAR B.Sc. (M.E.D)., M.B.B.S.,

    1. Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
    2. Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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  • CATHERINE SMITH B.Sc.(HONS)., M.Sc., M.P.H.,

    1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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  • JOSEPH B. MORTON M.B.B.S., Ph.D.,

    1. Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
    2. Melbourne Private Hospital, Parkville, Victoria, Australia
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  • JONATHAN M. KALMAN M.B.B.S., Ph.D.,

    1. Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
    2. Melbourne Private Hospital, Parkville, Victoria, Australia
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  • PETER M. KISTLER M.B.B.S., Ph.D.

    Corresponding author
    1. Melbourne Private Hospital, Parkville, Victoria, Australia
    2. Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
    • Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
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  • Supported in part by the Victorian Government's Operational Infrastructure Support Program.

  • Dr. McLellan is supported by a cofunded NHMRC/NHF Postgraduate Scholarship and BakerIDI Scholarship. Dr. Kumar is supported by a cofunded NHMRC/NHF Postgraduate Scholarship. A/Professor Kistler is supported by a practitioner fellowship from the NHMRC. All other authors have reported that they have no financial relationships to disclose.

Address for correspondence: Peter Kistler, M.B.B.S., Ph.D., Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, Australia 3004. Fax: +38-532-1111; E-mail: peter.kistler@bakeridi.edu.au

A Systematic Review of Adenosine in AF Ablation

 Introduction

Pulmonary vein reconnection is a major limitation of pulmonary vein isolation (PVI) for symptomatic atrial fibrillation (AF). Adenosine may unmask dormant PV conduction and facilitate consolidation of PV isolation.

We performed a systematic review of the literature to determine the impact of routine adenosine administration on clinical outcomes in patients undergoing PVI.

Methods

References and electronic databases reporting AF ablation and adenosine following PVI were searched through to 31 July 2012. Six studies included 544 patients to assess the impact of catheter ablation to target adenosine-induced PV reconnection on AF ablation outcome and 3 studies included 612 patients to assess the impact of adenosine testing on AF ablation outcome. Relative risks were calculated and combined in a meta-analysis using random effects modeling.

Results

Routine adenosine testing for PV reconnection with additional targeted ablation resulted in a significant increase in freedom from AF post-PVI (RR 1.25; 95% CI 1.12–1.40; P < 0.001). However, within the group of patients undergoing adenosine testing, those with reconnection identified a population with a trend to reduction in freedom from AF despite the use of further targeted ablation in the reconnection group (RR 0.91 with 95% CI 0.81–1.03; P = 0.15).

Conclusion

Routine adenosine testing is associated with an improvement in freedom from AF post-PVI. Paradoxically acute adenosine-induced PV reconnection may portend a greater likelihood of AF recurrence despite additional ablation. Randomized controlled trials are required to determine the role of adenosine testing post-PVI.

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