Table 1.
Clinical, procedural and outcome data of the studies included in the meta-analysis.
| Ref. | Study design | No of pts | Study groups | No of pts in each group | PAF | Age (years) | Males [%] | FU (days) | Duration of AF (years) | LA size (mm) | LVEF (%) | Prior ablation | Adenosine protocol | Primary end point | Freedom of primary endpoint | Repeat ablation |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Randomized control trials | ||||||||||||||||
| Efremidis et al.[16] | Prosp | 161 | Adenosine guided PVI | 80 | 80 | 54.17±10.71 | 58 (72.5) | 342±157.5 | 4.4±3.65 | 39.75±5.25 | 61.17±4.77 | 0 | 12–24 mg of adenosine after 30 min waiting period | Documented symptomatic or asymptomatic AF episodes lasting >30 sec or documented AT after a 3-month blanking period | 50 (62.5%) | 8 (10%) |
| Subgroup with DC and additional ablation | 26 | 12 (46.2%) | 4 (15.3%) | |||||||||||||
| Subgroup without DC | 54 | 38 (70.4%) | 4 (7.4%) | |||||||||||||
| No adenosine | 81 | 81 | 56.65±11.50 | 52 (64.2) | 341.7±149.4 | 4.59±4.26 | 38.70±4.61 | 61.67±4.95 | 0 | N/A | 54 (66.7%) | |||||
| Ghanbari et al.[15] | Prosp | 129 | Adenosine guided PVI | 61 | 61 | 59.7±8.7 | 37 (61) | 278.6±211.9 | NA | 41±5.3 | 59.7±5.4 | 20 (33) | 6–24 mg of adenosine for each PV and ISP at rates of 5,10,15 and 20 μg/min for 2 min at each infusion rate | Recurrence of AF | 37 (61%) | 12 (20%) |
| Subgroup with DC and additional ablation | 23 | |||||||||||||||
| Subgroup without DC | 38 | |||||||||||||||
| No adenosine | 68 | 68 | 58.9±10.7 | 53 (78) | 278.6±211.9 | N/A | 41.2±6.4 | 59.3±5.6 | 20 (29) | ISP infusion at same rates as above | 45 (66%) | 9 (43%) | ||||
| Kobori et al.[14] | Prosp | 2113 | Adenosine guided PVI | 1112 | 737 | 58.6±8.6 | 856 (77) | 365 | N/A | 38.9±6.3 | 64.2±7.9 | 0 | ATP 0.4 mg/kg body weight after a median waiting period of 57 [33–87] min | Recurrent AT lasting for 30 sec or those requiring repeat ablation, hospital admission, or usage of Vaughan Williams class I or III anti-arrhythmic drugs at 1 year with the blanking period of 90 days post-ablation | 625 (69%) | N/A |
| Subgroup with DC and additional ablation | 307 | 163 (64%) | N/A | |||||||||||||
| Subgroup without DC | 805 | 462 (71%) | N/A | |||||||||||||
| No adenosine | 1001 | 683 | 68.5±8.8 | 723 (73) | 365 | N/A | 39.2±6.2 | 64.6±7.3 | 0 | ISP infusion was not mandatory in the adenosine test | 533 (67%) | N/A | ||||
| Macle et al.[13] | Prosp | 401 | DC and additional ablation | 147 | 147 | 60.2±9.9 | 108 (74) | 368±43 | 4 (1.5–7) | 40.1±4.5 | 59.9±5.8 | 0 | 12 mg of adenosine after 20 min waiting period | Freedom from symptomatic AF, Af, AT after a single ablation procedure between 91–365 days after the procedure | 102 (69%) | 30 (20%) |
| DC, no further ablation | 137 | 137 | 58.4±9.7 | 97 (71) | 368±43 | 3.4 (1.7–8) | 39.6±5.9 | 60.1±7.1 | 0 | As above | 58 (42%) | 48 (35%) | ||||
| No DC | 117 | 117 | 58.9±10.9 | 87 (74) | 368±43 | 3 (1.3–8) | 40.1±4.9 | 59.1±6.6 | 0 | As above | 64 (56%) | N/A | ||||
| Observational studies | ||||||||||||||||
| Cheung et al.[12] | Prosp | 152 | DC and additional ablation | 44 | 29 | 62±9 | 34 | 374 | NA | 40±0.6 | 60±11 | 0 | 12 mg of adenosine without waiting period | Recurrence of AF was defined as any AT or AF recorded lasting ≥30 sec after a 3 month blanking period | 28 (64%) | 5 (11%) |
| (77) | (323–418) | |||||||||||||||
| No DC | 108 | 67 | 60±11 | 86 | 374 | NA | 43±0.7 | 59±11 | 0 | As above | 82 (76%) | 13 (12%) | ||||
| (80) | (323–418) | |||||||||||||||
| Miyazaki et al.[11] | Retrosp | 109 | DC and additional ablation | 39 | 39 | 59.4±10.3 | 33 (85) | 365 | 4.7±3.6 | 39.4±5.5 | 66.4±9 | N/A | 40 mg ATP without waiting period | Recurrence of AF after a 1 month blanking period after ablation | 20 (51%) | 10 (26%) |
| No DC | 70 | 70 | 61.4±11.2 | 58 (83) | 365 | 5.05±4.9 | 38.1±5.4 | 65.8±8.3 | N/A | 51 (73%) | 22 (31%) | |||||
| Matsuo et al.[9] | Retrosp | 233 | DC and additional ablation | 139 | 89 | 54.±9.6 | 122 (88) | 903±394 | 4.5±4 | 38.5±5.5 | 65.9±6.6 | N/A | 20 mg ATP after 20 min waiting period under ISP infusions at a rate of 5 up to 20 μg/min | Maintenance of SR (no sustained AT >30 sec) without AAD during the entire follow-up period (minimum 12 months) after a 1 month blanking period after ablation | 87 (63%) | 43 (31%) |
| No DC | 94 | 55 | 54.2±10.9 | 84 (89) | 903±394 | 4.3±3.7 | 39.7±5.7 | 65.8±7.4 | N/A | 62 (66%) | 28 (30%) | |||||
| Kumagai et al.[10] | Retrosp | 206 | Adenosine guided PVI | 106 | 94 | 58±11 | 74 (70) | 480±156 | 4.5±3.9 | 39.4±5.4 | 65.1±8.9 | N/A | 10 mg ATP during ISP infusion (5 μg/min) without waiting period | Recurrence of AF (sustained AF lasting more than 1 min) | 81 (76%) | 11 (10%) |
| Subgroup with DC and additional ablation | 54 | |||||||||||||||
| Subgroup without DC | 52 | |||||||||||||||
| No adenosine | 106 | 86 | 59±10 | 83 (78) | 480±207 | 5.0±5.5 | 39.7±5.7 | 63.8±9.6 | N/A | ISP infusion as above | 66 (62%) | 10 (9%) | ||||
| Hachiya et al.[8] | Retrosp | 252 | Adenosine guided PVI | 82 | 62 | 56±9 | 67 (82) | 183±99 | N/A | 41.7±6 | N/A | N/A | 30 mg ATP during ISP infusion (1–3 μg/min) without waiting period | Recurrence of AF | 60 (73%) | N/A |
| Subgroup with DC and additional ablation | 34 | 23 (68%) | ||||||||||||||
| Subgroup without DC | 48 | 37 (77%) | ||||||||||||||
| No adenosine | 170 | 135 | 54±9 | 143 (84) | 183±99 | N/A | 41.3±6 | N/A | N/A | 102 (60%) | N/A | |||||
| Tritto et al.[7] | Prosp | 29 | Adenosine induced PV activity | 16 | N/A | N/A | 12 mg of adenosine after 10 min waiting period | Recurrence of AF | 11 (69%) | |||||||
| No PV activity | 13 | 21 | 55.3±7.6 | 21 (72) | 189±72 | 5 (3–8) | 43.3±4.2 | 9 (69%) | 6 (21%) | |||||||