Abstract
Background
Ablation is used for treatment of atrial fibrillation (AF) but recurrence is common.
Dormant conduction is hypothesized to be responsible for these recurrences, and the
role of adenosine in identification and ablation of these pathways is controversial
with conflicting results on AF recurrence.
Materials and Methods
We conducted a meta-analysis for studies evaluating AF ablation and adenosine use.
Included in the meta-analysis were human studies that compared ablation using adenosine
or adenosine triphosphate (ATP) and reported freedom from AF in patients beyond a
minimum follow-up of 6 months.
Results
Our analysis suggests that the use of adenosine leads to a decrease in recurrence
of AF compared to the cohort which did not utilize adenosine. Subgroup analysis showed
no difference in the recurrence of AF with the modality used for ablation (cryoablation
vs. radiofrequency ablation) or with the preparation of adenosine used (ATP vs. adenosine).
There was a significant benefit in delayed administration of ATP over early administration.
Pooling results of only randomized control trials did not show any significant difference
in AF recurrence.
Conclusions
Adenosine-guided identification and ablation of dormant pathways may lead to a decrease
in recurrence of AF.
Key Indexing Terms
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References
- 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.Circulation. 2014; : e199-e267
- Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial.J Am Med Assoc. 2010; 303: 333-340
- Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial.J Am Med Assoc. 2014; 311: 692-700
- 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society.Heart rhythm. 2012; 9 (e621): 632-696
- Persistence of pulmonary vein isolation after robotic remote-navigated ablation for atrial fibrillation and its relation to clinical outcome.J Cardiovasc Electrophysiol. 2010; 21: 1079-1084
- Catheter ablation and antiarrhythmic drug therapy as first- or second-line therapy in the management of atrial fibrillation: systematic review and meta-analysis.Circ Arrhythm Electrophysiol. 2014; 7: 853-860
- Architecture of the pulmonary veins: relevance to radiofrequency ablation.Heart. 2001; 86: 265-270
- 2012 HRS/EHRA/ECAS Expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design.Europace. 2012; 14: 528-606
- Dormant pulmonary vein conduction revealed by adenosine after ostial radiofrequency catheter ablation.J Cardiovasc Electrophysiol. 2004; 15: 1041-1047
- Mechanisms by which adenosine restores conduction in dormant canine pulmonary veins.Circulation. 2010; 121: 963-972
- Pulmonary vein isolation using a pace-capture-guided versus an adenosine-guided approach: effect on dormant conduction and long-term freedom from recurrent atrial fibrillation—a prospective study.Circ Arrhythm Electrophysiol. 2013; 6: 1103-1108
- Incidence and predictors of dormant conduction after cryoballoon ablation incorporating a 30-min waiting period.Europace. 2015; 17: 1383-1390
- Administration of isoproterenol and adenosine to guide supplemental ablation after pulmonary vein antrum isolation.J Cardiovasc Electrophysiol. 2013; 24: 1199-1206
- Role of adenosine after antral pulmonary vein isolation of paroxysmal atrial fibrillation: A randomized controlled trial.Heart rhythm. 2016; 13: 407-415
- Clinical implications of reconnection between the left atrium and isolated pulmonary veins provoked by adenosine triphosphate after extensive encircling pulmonary vein isolation.J Cardiovasc Electrophysiol. 2007; 18: 392-398
- Adenosine triphosphate-guided pulmonary vein isolation for atrial fibrillation: the UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate (UNDER-ATP) trial.Eur Heart J. 2015; 36: 3276-3287
- ATP-induced dormant pulmonary veins originating from the carina region after circumferential pulmonary vein isolation of atrial fibrillation.J Cardiovasc Electrophysiol. 2010; 21: 494-500
- Adenosine testing after second-generation cryoballoon ablation (ATSCA) study improves clinical success rate for atrial fibrillation.Europace. 2015; 17: 871-876
- Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial.Lancet. 2015; 386: 672-679
- Reduction of AF recurrence after pulmonary vein isolation by eliminating ATP-induced transient venous re-conduction.J Cardiovasc Electrophysiol. 2007; 18: 704-708
- Adenosine testing after cryoballoon pulmonary vein isolation improves long-term clinical outcome.Neth Heart J. 2012; 20: 447-455
- Repeated provocation of time- and ATP-induced early pulmonary vein reconnections after pulmonary vein isolation: eliminating paroxysmal atrial fibrillation in a single procedure.Circ Arrhyth Electrophysiol. 2011; 4: 601-608
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.Br Med J. 2009; 339: b2700
- Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.J Am Med Assoc. 2000; 283: 2008-2012
- Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up?.J Am Coll Cardiol. 2011; 57: 160-166
- Cochrane Handbook for Systematic Reviews of Interventions. 2011;
- Bias in meta-analysis detected by a simple, graphical test.Br Med J. 1997; 315: 629-634
Wells GA SB, O′Connell D, Peterson J,Welch V,Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.pp.
- The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.Br Med J. 2011; 343: d5928
- Observational studies versus randomized controlled trials: avenues to causal inference in nephrology.Adv Chronic Kidney Dis. 2012; 19: 11-18
- Impact of atrial fibrillation on mortality, stroke, and medical costs.Arch Intern Med. 1998; 158: 229-234
Article info
Publication history
Published online: October 11, 2017
Accepted:
September 18,
2017
Received in revised form:
September 5,
2017
Received:
January 17,
2017
Footnotes
The authors declare no financial or other conflicts of interest.
Identification
Copyright
© 2017 Southern Society for Clinical Investigation. Published by All rights reserved.
