Introduction
The pulmonary veins (PV) are the most frequent trigger source of atrial
fibrillation (AF) and PV isolation is the cornerstone of catheter
ablation for AF.1 Non-PV foci are occasionally
identified during the ablation procedure, and isoproterenol (ISP) are
commonly utilized to elicit the AF triggers.2
An intravenous injection of adenosine triphosphate (ATP) or adenosine
has been used to unmask dormant conduction following isolation of
pulmonary veins (PVs).3 It has also been known that
intravenous ATP may induce AF.4 ATP produced the same
cardiac effects and share similar receptor-effector coupling systems
with acetylcholine.5 ATP injection enhances
parasympathetic activity followed by responsive sympathetic
hyperactivity. However, the association between ATP injection and
hyperactivity of the intrinsic cardiac autonomic nervous system, known
as ganglionated plexus (GP) were not well-understood.
In this retrospective study, we describe a series of patients with
non-PV trigger site provoked by ATP injection, and assess the
feasibility of GP ablation.