The Role of Lead Integrity Alerts and Remote Monitoring in Reducing Morbidity Associated With the St Jude Medical Riata ICD Lead

Abstract

Introduction: Pulmonary vein reconnection is a major limitation of pulmonary vein isolation (PVI) for symptomatic atrial fibrillation (AF). Adenosine may unmask dormant PV conduction and facilitate consolidation of PV isolation. 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 31st 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 three 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 modelling. 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 reconnection may portend a greater likelihood of AF recurrence despite additional ablation. Randomised controlled trials are required to determine the role of adenosine testing post PVI.