Effects of adenosine triphosphate on ventriculoatrial conduction--usefulness and problems in assessment of catheter ablation of accessory pathways.
The effects of adenosine triphosphate (ATP) on ventriculoatrial (VA) conduction were examined before and after accessory pathway (AP) ablation, with emphasis on assessment of the complication of dual atrioventricular (AV) node pathway. By evaluating the differences in the response to ATP of APs and other pathways, we assessed the usefulness and problems of this method. Of 59 patients who underwent AP ablation, 31 showed pre-excitation and 28 had concealed APs. A dual AV node pathway was found in 9 patients (15.3%) before ablation. After ablation, a dual AV node pathway was newly found in 9 patients. Thus, the total number of patients with a dual AV node pathway was 18 (30.5%). VA conduction over APs was not blocked in 26 of 29 patients, but the remaining 3 APs were blocked transiently by ATP. ATP caused VA block over the AV node in 15 of 16 patients and a dual AV node pathway in all 11 patients. In contrast, VA conduction over the retrograde fast pathway was blocked in 9 of 14 patients with AV node re-entrant tachycardia. ATP has little effect on APs, so observation of the response to ATP provides a more reliable and useful means of evaluating successful ablation. With this method, however, it is important to consider the possibility of the presence of ATP-sensitive APs and ATP-resistant retrograde fast pathways. The influence of ablation-induced injury has not been fully clarified. It is therefore essential to take into account various data, including the comparison between data obtained before and after ablation.
Miyata
A
A
Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.
Kobayashi
Y
Y
Jinbo
Y
Y
Chiyoda
K
K
Nakagawa
H
H
Tanno
K
K
Kurano
K
K
Kikushima
S
S
Baba
T
T
Katagiri
T
T
D000255:Adenosine Triphosphate / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001283:Atrioventricular Node / Q000187:drug effects* / Q000503:physiopathology; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014927:Wolff-Parkinson-White Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery
D000255:Adenosine Triphosphate