Key result
Adenosine triphosphate significantly decreased mean atrial fractionation intervals (110.4 to 90.5 ms, P<0.0001) and increased dominant frequencies (6.4 to 7.1 Hz, P<0.0001) in AF patients.
Why the study?
Does bolus injection of ATP alter atrial electrogram fractionation intervals and dominant frequencies in patients with atrial fibrillation?
Does bolus injection of ATP alter atrial electrogram fractionation intervals and dominant frequencies in patients with atrial fibrillation?
p-value: p=<0.0001
ATP shortens atrial fractionation intervals and increases dominant frequencies in AF patients, with a more pronounced dominant frequency increase in paroxysmal AF, suggesting progressive atrial remodeling affects frequency responses.
ATP modulation of LA CFAEs/DF is unclear in this small observational series; leaves open whether ATP-sensitive sites warrant targeted ablation.
BACKGROUND: Complex fractionated atrial electrograms (CFAEs) and high dominant frequency (DF) are targets for atrial fibrillation (AF) ablation. Although adenosine triphosphate (ATP) is known to promote AF by shortening the atrial refractory period, its role in the pathogenesis of CFAEs and DF during AF is not fully understood. METHODS: We recorded electrical activity from a 64-electrode basket catheter placed in the left atrium (LA) of patients with paroxysmal AF (PAF, n=18) or persistent AF (PerAF, n=19) before ablation. Atrial electrogram fractionation intervals (FIs) and DFs were measured from bipolar electrograms of each adjacent electrode pair. Offline mean atrial FIs and DFs were obtained before bolus injection of 30 mg ATP. Peak effect was defined as an R-R interval >3 s. RESULTS: With ATP, the mean FI decreased (from 110.4±29.1 ms to 90.5±24.7 ms, P<0.0001) and DF increased (from 6.4±0.6 Hz to 7.1±0.8 Hz, P<0.0001) in all patients. There was no difference in the FI decrease between the two groups (-20.3±20.5 ms vs. -19.6±14.5 ms, P=0.6032), but the increase in DF was significantly greater in PAF patients (1.1±0.8 Hz vs. 0.3±0.6 Hz, P=0.0051). CONCLUSIONS: ATP shortens atrial FIs and increases DFs in both PAF and PerAF patients. The significant increase in DF in PAF patients suggests that pathophysiologic characteristics related to the frequency of atrial fractionation change as atrial remodeling progresses.
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Kogawa et al. (2015) studied Atrial fibrillation (n=37). Adenosine triphosphate (ATP) vs. Baseline (before injection) was evaluated on Mean atrial fractionation intervals (FIs) and dominant frequencies (DFs) (p=<0.0001). Adenosine triphosphate significantly decreased mean atrial fractionation intervals (110.4 to 90.5 ms, P<0.0001) and increased dominant frequencies (6.4 to 7.1 Hz, P<0.0001) in AF patients.
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