Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials
Background: The prognostic significance of adenosine-mediated dormant pulmonary vein conduction, and whether such dormant conduction should be eliminated, remains controversial. We sought to perform a meta-analysis of data from eligible studies to delineate the prognostic impact of adenosine-guided...
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| Format: | Article |
| Language: | English |
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Wiley
2017-08-01
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| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S188042761730025X |
| _version_ | 1819170925374865408 |
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| author | Konstantinos P. Letsas, MD, FESC, FEHRA Stamatis Georgopoulos, MD Michael Efremidis, MD Tong Liu, MD, PhD George Bazoukis, MD, MSc Konstantinos Vlachos, MD Nikolaos Karamichalakis, MD Louiza Lioni, MD Antonios Sideris, MD Joachim R. Ehrlich, MD, FESC, FHRS, FAHA |
| author_facet | Konstantinos P. Letsas, MD, FESC, FEHRA Stamatis Georgopoulos, MD Michael Efremidis, MD Tong Liu, MD, PhD George Bazoukis, MD, MSc Konstantinos Vlachos, MD Nikolaos Karamichalakis, MD Louiza Lioni, MD Antonios Sideris, MD Joachim R. Ehrlich, MD, FESC, FHRS, FAHA |
| author_sort | Konstantinos P. Letsas, MD, FESC, FEHRA |
| collection | DOAJ |
| description | Background: The prognostic significance of adenosine-mediated dormant pulmonary vein conduction, and whether such dormant conduction should be eliminated, remains controversial. We sought to perform a meta-analysis of data from eligible studies to delineate the prognostic impact of adenosine-guided radiofrequency catheter ablation of atrial fibrillation.
Methods: A systematic literature search was performed using online databases in order to identify relevant studies from January 2004 to September 2016. Ten studies [six observational and four randomized control trials (RCTs)] were included in the analysis.
Results: Five studies (two observational and three RCTs) compared the efficacy of adenosine-mediated elimination of dormant conduction versus no adenosine test. Overall, the adenosine-guided ablation strategy displayed better long-term outcomes as compared with no adenosine testing (RR 1.08, 95% CI 1.01–1.14, p=0.02; Heterogeneity: I2=42%, p: 0.14). The meta-analysis of only RCTs failed to show any differences between the two strategies (RR 1.03, 95% CI 0.96–1.11, p=0.37; Heterogeneity: I2 0%, p: 0.41). Eight studies (five observational and three RCTs) addressed the efficacy of adenosine-induced dormant conduction and additional ablation versus no dormant conduction during adenosine challenge. Overall, a trend towards a better outcome in those without dormant conduction during drug challenge was noted (RR 0.89, 95% CI 0.77–1.03, p=0.11; Heterogeneity: I2 65% p: 0.006). The pooled analysis of RCTs failed to show any differences between the two arms (RR 0.90, 95% CI 0.62–1.30, p= 0.57; Heterogeneity: I2 88%, p: 0.0002).
Conclusions: Adenosine-guided radiofrequency catheter ablation of atrial fibrillation does not provide additional benefit in terms of freedom of arrhythmia recurrence. |
| first_indexed | 2024-12-22T19:43:08Z |
| format | Article |
| id | doaj.art-2acaa08017714e28b8828f94efe986a0 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 |
| language | English |
| last_indexed | 2024-12-22T19:43:08Z |
| publishDate | 2017-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-2acaa08017714e28b8828f94efe986a02022-12-21T18:14:46ZengWileyJournal of Arrhythmia1880-42762017-08-0133424725510.1016/j.joa.2017.02.002Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trialsKonstantinos P. Letsas, MD, FESC, FEHRA0Stamatis Georgopoulos, MD1Michael Efremidis, MD2Tong Liu, MD, PhD3George Bazoukis, MD, MSc4Konstantinos Vlachos, MD5Nikolaos Karamichalakis, MD6Louiza Lioni, MD7Antonios Sideris, MD8Joachim R. Ehrlich, MD, FESC, FHRS, FAHA9Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, GreeceLaboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, GreeceLaboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, GreeceDepartment of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People׳s Republic of ChinaLaboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, GreeceLaboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, GreeceLaboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, GreeceLaboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, GreeceLaboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, GreeceElectrophysiology Section, St. Josefs-Hospital, Wiesbaden, GermanyBackground: The prognostic significance of adenosine-mediated dormant pulmonary vein conduction, and whether such dormant conduction should be eliminated, remains controversial. We sought to perform a meta-analysis of data from eligible studies to delineate the prognostic impact of adenosine-guided radiofrequency catheter ablation of atrial fibrillation. Methods: A systematic literature search was performed using online databases in order to identify relevant studies from January 2004 to September 2016. Ten studies [six observational and four randomized control trials (RCTs)] were included in the analysis. Results: Five studies (two observational and three RCTs) compared the efficacy of adenosine-mediated elimination of dormant conduction versus no adenosine test. Overall, the adenosine-guided ablation strategy displayed better long-term outcomes as compared with no adenosine testing (RR 1.08, 95% CI 1.01–1.14, p=0.02; Heterogeneity: I2=42%, p: 0.14). The meta-analysis of only RCTs failed to show any differences between the two strategies (RR 1.03, 95% CI 0.96–1.11, p=0.37; Heterogeneity: I2 0%, p: 0.41). Eight studies (five observational and three RCTs) addressed the efficacy of adenosine-induced dormant conduction and additional ablation versus no dormant conduction during adenosine challenge. Overall, a trend towards a better outcome in those without dormant conduction during drug challenge was noted (RR 0.89, 95% CI 0.77–1.03, p=0.11; Heterogeneity: I2 65% p: 0.006). The pooled analysis of RCTs failed to show any differences between the two arms (RR 0.90, 95% CI 0.62–1.30, p= 0.57; Heterogeneity: I2 88%, p: 0.0002). Conclusions: Adenosine-guided radiofrequency catheter ablation of atrial fibrillation does not provide additional benefit in terms of freedom of arrhythmia recurrence.http://www.sciencedirect.com/science/article/pii/S188042761730025XAblationAtrial fibrillationPulmonary veinsAdenosineDormant conduction |
| spellingShingle | Konstantinos P. Letsas, MD, FESC, FEHRA Stamatis Georgopoulos, MD Michael Efremidis, MD Tong Liu, MD, PhD George Bazoukis, MD, MSc Konstantinos Vlachos, MD Nikolaos Karamichalakis, MD Louiza Lioni, MD Antonios Sideris, MD Joachim R. Ehrlich, MD, FESC, FHRS, FAHA Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials Journal of Arrhythmia Ablation Atrial fibrillation Pulmonary veins Adenosine Dormant conduction |
| title | Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials |
| title_full | Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials |
| title_fullStr | Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials |
| title_full_unstemmed | Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials |
| title_short | Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials |
| title_sort | adenosine guided radiofrequency catheter ablation of atrial fibrillation a meta analysis of randomized control trials |
| topic | Ablation Atrial fibrillation Pulmonary veins Adenosine Dormant conduction |
| url | http://www.sciencedirect.com/science/article/pii/S188042761730025X |
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