Key result
Adenosine triphosphate (ATP) injection triggered atrial fibrillation without pulmonary vein reconnection, revealing complex fractionated atrial electrograms as essential ablation targets.
Why the study?
Does ATP injection after pulmonary vein isolation reveal extra-pulmonary vein sources of atrial fibrillation?
Case Report
Does ATP injection after pulmonary vein isolation reveal extra-pulmonary vein sources of atrial fibrillation?
ATP injection after pulmonary vein isolation can reveal extra-pulmonary vein sources of atrial fibrillation, such as complex fractionated atrial electrograms, which may require further ablation for efficacy.
ATP may unmask extra-PV CFAE targets post-PVI; leaves open whether ablation improves outcomes.
Noninducibility of atrial fibrillation (AF) by additional electrograms-guided ablation may benefit the clinical outcome. This report illustrates the effect of adenosine triphosphate (ATP) injection on AF inducibility after pulmonary vein (PV) isolation. AF was triggered twice by ATP without PV reconnection. Meanwhile, complex fractionated atrial electrograms (CFAEs) were observed, and ablation targets on these sites appeared to be essential to the AF elimination. It suggests that CFAEs may contribute to the initiation of some AF. ATP may be useful to induce AF after proven PV isolation, and further ablation might be necessary to ensure efficacy after circumferential PV isolation.
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Jiang et al. (2009) conducted a case report in Atrial fibrillation after circumferential pulmonary vein isolation. Adenosine triphosphate (ATP) injection was evaluated on Atrial fibrillation inducibility. Adenosine triphosphate (ATP) injection triggered atrial fibrillation without pulmonary vein reconnection, revealing complex fractionated atrial electrograms as essential ablation targets.
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