The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

Table 1

Radiofrequency ablation studies addressing adenosine use in PVI.

Study

Comparison groups

(%)

veins

pAF (%)

Waiting time (min)

Adenosine dose (mg)

Tested; veins

Reconnected; veins (%)

Follow-up (months)

AF-free (%)

Redo procedure

Reconnected veins in redo

Adenosine given versus adenosine not given

Hachiya et al.  (2007) [12]; Retrospective

252

Adenosine given; Adenosine not given

82; 170

164; —

62 (76); 135 (79)

—; —

30; —

164; —

41 (25%) in 34 patients (41%); —

6.1 ± 3.3

60 (73%); 102 (60%)

0.04

—

—

Matsuo et al.; (2007) [13]; Retrospective

148

Adenosine given; Adenosine not given

54; 94

224; —

36 (67); 60 (64)

20; —

20; —

224; —

59 (26%) in 30 patients (56%); —

19.9 ± 6

43 (80%); 56 (60%)

<0.05

9 (17%); 36 (38%)

DC+; DC−

8/14 (57%); 12/22 (55%)

Kumagai et al.; (2010) [14]; Retrospective

212

Adenosine given; Adenosine not given

106; 106

216; —

94 (89); 86 (81)

—; —

10; —

216; —

90 (42%) in 54 patients (51%); —

16 ± 5; 16 ± 7

81 (76%); 66 (62%)

0.03

11 (10%); 10 (9.4%)

—; —

Kobori et al.; (2015) [11]; Randomized Prospective

2113

Adenosine given; Adenosine not given

1112; 1001

—

1420 (67%)

43; —

0.4 mg/kg; —

—; —

307 in 1112 patients (27.6%); —

12

68.7%; 67.1%

0.25

—

—

Reconnection versus no reconnection

Tritto et al.; (2004) [19]; Prospective

29

Reconnection; No reconnection

16 (55); 13 (45)

74

21 (72)

10

12

62

22 (35%); 0

6.3 ± 2.4

11 (69%); 9 (69%)

1

6

DC+; DC−

6/8 (75%); 4/5 (80%)

Arentz et al.; (2004) [6]; Prospective

29

Reconnection; No reconnection

13 (45); 16 (55)

83

20 (69)

0

12–18

53

13 (24%); 0

12

5 (38%); 7 (44%)

1

14

DC+; DC−

5/7 (71%); 7/20 (35%)

Hachiya et al.; (2007) [12]; Retrospective

82

Reconnection; No reconnection

34 (41); 48 (59)

164

62 (76)

0

30

164

41 (25%); 0

6.1 ± 3.3

23 (68%); 37 (77%)

—

—

—

Matsuo et al.; (2010) [17]; Retrospective

233

Reconnection; No reconnection

139 (60); 94 (40)

930

144 (62)

20

20

928

225; 0

29 ± 13

87 (62.6%); 62 (66%)

0.69

43 (31%); 28 (30%)

DC+; DC−

42/78 (54%); 119/202 (59%)

Gula et al.; (2011) [16]; Prospective

72

Reconnection; No reconnection

25 (35); 47 (65)

50; 94

25 (100); 47 (100)

30

12

50; 94

29 (58%); 0

12

19 (76%); 35 (74%)

1

6 (24%); 12 (26%)

DC+; DC−

9/10 (90%); 22/26 (85%)

Miyazaki et al.; (2012) [18]; Prospective

109

Reconnection; No reconnection

39 (36); 70 (64)

78; 140

39 (100); 70 (100)

0

40

78; 140

42 (54%); 0

12

20 (51%); 51 (73%)

0.03

10 (26%); 22 (31%)

DC+; DC−

6/10 (60%); 27/54 (50%)

Anter et al.; (2014) [15]; Prospective

44

Reconnection; No reconnection

16 (36); 28 (64)

—

8 (50); 16 (57)

30

12–48

—

26; 0

12

8 (50%); 25 (89%)

0.009

3 (7%)

—; —

Macle et al.; (2015) [10]; Randomized Prospective

401

Reconnection and no ablation; Reconnection and ablation; No reconnection

147 (28); 137 (26); 117

—; —; —

147 (100); 137 (100); 117 (100)

20

12–18

2085

—; —; 0

12

42.3%; 69.4%; 55.7%

<0.001; 0.019

110

88%; 48%; 55%

Veins considered and tested per pair; no further ablation in case of dormant conduction; historical cohort as comparator; out of 250 patients without dormant conduction 117 were randomized to intense follow-up registry. ^#This study specified the freedom from any atrial tachycardia as the primary endpoint. DC+: veins with dormant conduction at first procedure; DC−: veins without dormant conduction at first procedure; pAF: paroxysmal atrial fibrillation.