The role of adenosine following pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a systematic review

Pulmonary vein reconnection is a major limitation of pulmonary vein isolation (PVI) for symptomatic atrial fibrillation (AF). Adenosine mayunmask dormantPVconduction and facilitate consolidation ofPVisolation.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 reconnectionmay portend a greater likelihood of AF recurrence despite additional ablation. Randomized controlled trials are required to determine the role of adenosine testing post-PVI. (J Cardiovasc Electrophysiol, Vol. 24, pp. 742-751, July 2013)