title: Clinical impact of adenosine triphosphate injection on arrhythmogenic superior vena cava in the context of atrial fibrillation ablation.
abstract: BACKGROUND
  Superior vena cava (SVC) is an infrequent yet an important source of atrial fibrillation. The clinical impact of ATP injection on arrhythmogenic SVC has not been evaluated.
  
  
  RESULTS
  A total of 43 patients (59±11 years; men, 32) who underwent ATP test for arrhythmogenic SVC after the electric isolation at either initial procedure or repeat procedure were included. Pulmonary vein antrum isolation was performed at index procedure in all patients. SVC was isolated after identifying the arrhythmogenicity at index and repeat atrial fibrillation ablation procedure in 34 (79.1%) and 9 (20.9%) patients, respectively. Atrial fibrillation originated from the SVC spontaneously and under isoproterenol infusion in 30 (75.0%) patients, and immediately after ATP injection in 10 (25.0%) patients. Tachycardia persistently confined to SVC was recorded after electric isolation in 13 (30.2%) patients. SVC reconnection was provoked by ATP test in 7 of 36 (19.4%) patients at acute phase. At median 4.0 (2.25-7.5) months after SVC isolation, reconnection was observed in 12 of 15 (80.0%) patients at repeat procedure. Among 12 patients with reconnection at baseline, SVC reconnection was provoked by ATP test after reisolation in 1 (8.3%) patient. Among 3 patients without SVC reconnection at baseline, reconnection was provoked by ATP test at chronic phase in 1 patient.
  
  
  CONCLUSIONS
  Dormant conduction between an arrhythmogenic SVC and the right atrium can be exposed by ATP administration both immediately and late after isolation, potentially facilitating detection and ablation for isolation.
authors.affiliation: Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan. mshinsuke@k3.dion.ne.jp
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
mesh_terms: D000255:Adenosine Triphosphate / Q000494:pharmacology; D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000187:drug effects* / Q000503:physiopathology
chemical_list: D000255:Adenosine Triphosphate
keywords: adenosine; atrial fibrillation; catheter ablation; superior vena cava