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Catheter Ablation of Ganglionated Plexi in Patients with Adenosine Triphosphate Induced Atrial Fibrillation After Pulmonary Vein Isolation
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  • Taku Nishida,
  • Akihiro Takitsume,
  • Kaeko Hirai,
  • Junichi Sugiura,
  • Ayaka Keshi,
  • Koshiro Kanaoka,
  • Hiroki Yano,
  • Yukihiro Hashimoto,
  • Tomoya Ueda,
  • Hitoshi Nakagawa,
  • Onoue Kenji,
  • Tsunenari Soeda,
  • Makoto Watanabe,
  • Rika Kawakami,
  • Yoshihiko Saito
Taku Nishida
Nara Medical University
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Akihiro Takitsume
Nara Prefecture General Medical Center
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Kaeko Hirai
Nara Prefecture Western Medical Center
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Junichi Sugiura
Nara Medical University
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Ayaka Keshi
Nara Medical University
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Koshiro Kanaoka
Nara Medical University
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Hiroki Yano
Nara Medical University
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Yukihiro Hashimoto
Nara Medical University
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Tomoya Ueda
Nara Medical University
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Hitoshi Nakagawa
Nara Medical University
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Onoue Kenji
Nara Medical University
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Tsunenari Soeda
Nara Medical University
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Makoto Watanabe
Nara Medical University
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Rika Kawakami
Nara Medical University
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Yoshihiko Saito
Nara Medical University
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Abstract

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.