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

Wang, Nelson; Phan, Steven; Kanagaratnam, Aran; Kumar, Narendra; Phan, Kevin

doi:10.1016/j.hlc.2017.04.020

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…With these new visualization tools, it may suggest more vigilant testing following index ablation in this region could prevent future reconnections. It may also suggest waiting longer to test for entrance and exit block and consideration of more provocative methods such as an Adenosine challenge as described [18].…”

Section: Resultsmentioning

confidence: 99%

Characterization of pulmonary vein reconnection post Cryoballoon ablation

Shah

Adelstein

et al. 2019

Indian Pacing and Electrophysiology Journal

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Background The Arctic Front Cryoballoon System is a technology in which substrate alterations in patients with atrial fibrillation (AF) recurrence have not been well characterized. In this study, we evaluated sites of pulmonary vein (PV) reconnections and the accuracy of the Achieve™ circular mapping catheter in detecting these reconnections after cryoablation. Methods This study included 15 patients undergoing redo AF ablation after a prior single cryoablation procedure . PV reconnection sites were determined by measuring PV signals and high output pacing from 4 vectors of the Achieve catheter. The results were compared with a roving mapping catheter guided by rotational intracardiac echocardiography (ICE) in the left atrium. Results All patients had PV reconnections (2.1 ± 0.8 veins/patient). The left superior PV was most commonly reconnected (n = 11), whereas the right inferior PV was least likely (n = 3). Both carinas (left: n = 11; right: n = 7) and left atrial appendage ridge (n = 11) were also frequently reconnected. Mapping with the Achieve catheter showed a positive predictive value (PPV) 100% and negative predictive value (NPV) 96% when compared with ICE guided mapping. In 2 patients, right superior PV reconnection was not identified by the Achieve. Conclusion During redo AF ablation after index cryoablation, multiple PVs are usually reconnected, with both carinas and left atrial appendage ridge being common sites of reconnection. The Achieve mapping catheter was able to identify reconnection with high positive and negative predictive values.

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Section: Resultsmentioning

confidence: 99%

Characterization of pulmonary vein reconnection post Cryoballoon ablation

Shah

Adelstein

et al. 2019

Indian Pacing and Electrophysiology Journal

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“…Our findings are in contradiction with the results of a systematic review by Wang et al According to their analysis of 18 studies, 3,038 patients received adenosine and freedom from AF in those 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). They concluded that adenosine administration produced superior outcomes than no adenosine administration; however, adenosine reconnection was still associated with a greater likelihood of AF recurrence than patients with no adenosine reconnection, despite further ablation 26 . Our results are different.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of paroxysmal atrial fibrillation catheter ablation with and without pulmonary vein dormant conduction after adenosine challenge

Škála¹,

Přeček²,

Hutyra³

et al. 2020

BIOMED PAP

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Objectives. The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction is unclear. We prospectively followed patients with adenosine-mediated PV reconduction with a subsequent repeated ablation until there was no reconduction inducible with patients without reconduction after PV isolation. Method and Results. Consecutive patients (n=179) with paroxysmal atrial fibrillation (AF) without prior catheter ablation (CA) were enlisted in the study. We used a point-by-point CA and general anesthesia in all patients. Twenty minutes after PV isolation we administered adenosine in a dose sufficient to produce an atrioventricular block. If a dormant conduction was present (n=54) we performed additional ablation until there was no adenosine mediated reconduction inducible. During 36 months of follow-up, all patients were examined for eight 7-day ECG recordings. There was no difference in arrhythmia recurrence rate between patients with and without dormant conduction (29.6 vs. 24.8% at 12 months, P=0.500; 31.5 vs. 30.4% at 36 months, P=1.000), for any echocardiographic parameter or any parameter of the ablation procedure. Conclusion. The patients with dormant conduction after adenosine during catheter ablation of paroxysmal atrial fibrillation with complete elimination of the dormant conduction by additional extensive ablation have the same outcome in the long term as patients without a dormant conduction.

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“…The UNDER-ATP study and ADVICE trial are responsible for the majority of cases included in two recent systematic reviews and meta-analysis [3,9]. The meta-analysis of Wang et al included 22 comparative studies and randomized controlled trials.…”

Section: Discussionmentioning

confidence: 99%

“…It was shown that adenosine can be used to reveal dormant conduction of the PVs after PV isolation by increasing the resting potential of PV cells [1]. Publications on the usefulness and long-term outcome of adenosine use after PVI have come from relatively small clinical trials, observational studies, or randomized controlled trials with conflicting results [3]. The current guidelines for the management of atrial fibrillation consider adenosine testing to identify the need for additional ablation to be controversial [4].…”

Section: Introductionmentioning

confidence: 99%

Adenosine usage during AF ablation in Europe and selected long-term findings from the ESC-EHRA EORP Atrial Fibrillation Ablation Long-Term registry

Rosmalen

Delhaas

Dagres

et al. 2020

J Interv Card Electrophysiol

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Background Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI). This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation Long-Term registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety. Methods The registry consists of 104 participating centers in 27 countries within the European Society of Cardiology. The registry data was split into an adenosine group (AG) and no-adenosine group (NAG). Procedure characteristics and patient outcome were compared. Results Adenosine was administered in 10.8% of the 3591 PVI patients included in the registry. Spain, the Netherlands, and Italy included the majority of adenosine cases (48.8%). Adenosine was applied more often in combination with open irrigation radiofrequency (RF) energy (74.7%) and less often in combination with nonirrigated RF energy (1.6%). After 1 year, a higher percentage of the AG was free from AF compared with the NAG (68.9% vs 59.1%, p < 0.001). Adenosine was associated with better rhythm outcome in RF ablation procedures, but not in cryo-ablation procedures (freedom from AF: RF: AG: 70.9%, NAG: 58.1%, p < 0.001, cryo: AG: 63.9%, NAG: 63.8%, p = 0.991). Conclusions The use of adenosine was associated with a better rhythm outcome after 1 year follow-up and seems more useful in patients treated with RF energy compared with patients treated with cryo energy. Given the improved rhythm outcome at 1-year follow-up, it seems reasonable to encourage the use of adenosine during RF AF ablation.

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

Cited by 8 publications

References 35 publications

Characterization of pulmonary vein reconnection post Cryoballoon ablation

Characterization of pulmonary vein reconnection post Cryoballoon ablation

Long-term outcome of paroxysmal atrial fibrillation catheter ablation with and without pulmonary vein dormant conduction after adenosine challenge

Adenosine usage during AF ablation in Europe and selected long-term findings from the ESC-EHRA EORP Atrial Fibrillation Ablation Long-Term registry

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