Discussion
This retrospective case series describes non-PV, non-BOX, and non-SVC trigger sites provoked by ATP injection and demonstrates the effectiveness of the GP-based approach. The main findings of this study were:
The incidence of ATP-induced AF after PV/Box isolation and SVC isolation was 1.2%.
ATP-provoked trigger foci were distributed in particular sites, which overlapped with the distribution of GP.
Among these trigger foci, we proved the presence of GP by the vagal response to HFS in CS and RA posterior wall in six and two patients. CS- and RA-GP ablation suppressed the ATP-induced AF with a modest amount of RF application.
HFS within CS had a risk of ventricular fibrillation induction.