title: Adenosine-guided pulmonary vein isolation versus conventional pulmonary vein isolation in patients undergoing atrial fibrillation ablation: An updated meta-analysis.
abstract: 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.
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK; University College London, London, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papageorgiou
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK; University College London, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Srinivasan
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Kostas
authors.initials: K
authors.lastname: Bronis
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
authors.forename: Francisco Moscoso
authors.initials: FM
authors.lastname: Costa
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
authors.forename: Diogo
authors.initials: D
authors.lastname: Cavaco
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Adragão
authors.affiliation: 1(st) Cardiology Department, Athens University Medical School, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Hunter
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Segal
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Chow
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Rowland
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Lowe
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, London, UK; University College London, London, UK. Electronic address: p.lambiase@ucl.ac.uk.
authors.forename: Pier D
authors.initials: PD
authors.lastname: Lambiase
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000241:Adenosine
keywords: Adenosine; Arrhythmia; Atrial fibrillation; Catheter ablation; Pulmonary veins