Key result
Ganglionated plexus ablation was effective for ATP-induced atrial fibrillation after pulmonary vein isolation, rendering 100% (6 of 6) of re-tested patients non-inducible.
Why the study?
The association between ATP injection and hyperactivity of ganglionated plexi is not well-understood, prompting evaluation of non-PV triggers and feasibility of GP ablation.
Does ganglionated plexus ablation prevent ATP-induced atrial fibrillation in patients after pulmonary vein isolation?
Observational (n=7)
Does ganglionated plexus ablation prevent ATP-induced atrial fibrillation in patients after pulmonary vein isolation?
Ganglionated plexus ablation is feasible and effective for eliminating ATP-induced atrial fibrillation triggers after pulmonary vein isolation.
Hypothesis-generating for adjunctive ganglionated plexus ablation in ATP-induced AF; larger trials needed before any practice consideration.
Aims : Intravenous ATP may induce atrial fibrillation (AF). ATP shares similar receptor-effector coupling systems with acetylcholine. However, the association between an ATP injection and the hyperactivity of the intrinsic cardiac autonomic nervous system, known as ganglionated plexi (GPs), are not well-understood. We described a series of patients with non-pulmonary vein (PV) trigger sites provoked by an ATP injection, and assessed the feasibility of a ganglionated plexus (GP) ablation. Methods : Five hundred and ninety-nine consecutive patients (69% men; mean age, 68 ± years, 60% paroxysmal AF) were retrospectively examined. A total of 7 patients (1.2%) that had ATP-induced AF following a PV isolation were enrolled in this analysis. Results : The distribution of the foci overlapped the GP location; the coronary sinus (CS) in six patients, right atrial posterior wall (RAPW) adjacent to the interatrial groove in 2, mitral annulus in 2, ligament of Marshall in 1, right septum below the foramen ovale in 1 and left atrial posterior wall in 1, respectively. Among those trigger foci, we confirmed a vagal response by high frequency stimulation in the CS and RAPW in six and two patients, respectively. After a median RF time of 2.9 minutes (range 2.5 to 11.3) targeting those foci, six patients who received a repeat ATP injection became non-inducible. Conclusion : ATP-induced AF after a PV/Box isolation was associated with hyperactivity of atrial GP. The GP ablation was effective in this rare, but challenging situation.
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Nishida et al. (2020) conducted an observational in ATP-induced atrial fibrillation after pulmonary vein isolation (n=7). Ganglionated plexus (GP) ablation was evaluated on Non-inducibility of AF after repeat ATP injection. Ganglionated plexus ablation was effective for ATP-induced atrial fibrillation after pulmonary vein isolation, rendering 100% (6 of 6) of re-tested patients non-inducible.
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