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 61-3 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 = 175; 95 C1 132-233, p < 0.001, I-2 = 11%), retrospective (OR = 2.05; 95%Cl 147-2.86, p < 0.001, I-2 = 0%) and single-centre studies (OR = 1.58; 95%Cl 1.19-2.10, p = 0.002, I-2 = 30%). However, analysis of studies published since 2013 (OR = 1.41; 95% Cl 0.87-229, p = 0.17, I-2 = 75%) does not support any benefit from an adenosine-guided strategy. Similar findings were observed by pooling prospective case-control (OR = 1.39; 95%Cl 0.93-2.07, p = 0.11, I-2 = 75%), and prospective randomized controlled studies (OR = 1.62; 95%Cl 0.81-3.24, p = 0.17, I-2 = 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 Al ablation outcomes. (C) 2016 Published by Elsevier Ireland Ltd.