Intravenous ATP Challenge
We performed ATP challenge testing after a 60-minute waiting time since initial documentation of PV/BOX isolation.
Intravenous ATP (20 mg) was administered with immediate saline flush during an intravenous ISP infusion (0.5 to 1.0 μg/min). The dose of ISP infusion was adjusted to increase the heart rate over 100 beats per minute. The ATP effect was confirmed by the presence of temporary bradycardia and a decrease in blood pressure.
Double Lasso catheters were placed at the antrum of four PVs and/or SVC during the ATP challenge. If dormant PV conduction was identified, additional RF energy was applied to establish complete PV/BOX and/or SVC disconnection. Repeat ATP injections during ISP infusion were performed to reconfirm the complete disconnection of them.