title: Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome.
abstract: OBJECTIVE
  To evaluate the incidence and clinical outcome of adenosine triphosphate (ATP) plus isoproterenol (ISP)-induced non-pulmonary vein (PV) foci before and after circumferential PV isolation (CPVI) during index ablation in patients with paroxysmal atrial fibrillation (PAF).
  
  
  METHODS
  In 80 consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April 2010 to January 2011, atrial fibrillation (AF) was provoked with ATP (20 mg) and ISP (20 µg/min) administration before and after CPVI. The spontaneous initiation of AF was mapped and recorded.
  
  
  RESULTS
  Before ablation, AF mostly originating from PVs (PV vs. non-PV, 36/70 vs. 3/70; P<0.01) was induced in 39 patients with sinus rhythm. CPVI significantly suppressed AF inducibility; however, more non-PV foci were provoked (post-CPVI vs. pre-CPVI, 13/76 vs. 3/70; P=0.016). Patients with pre- and post-CPVI induced AF (n=49) were divided according to non-PV foci being induced (group N, n=17) or not (group P, n=32). After mean (19.2±8.2) months follow-up, 88.2% (15/17) and 65.6% (21/32) of patients in groups N and P, respectively, were free from AF recurrence (P=0.088).
  
  
  CONCLUSIONS
  ATP+ISP administration effectively provokes non-PV foci, especially after CPVI in PAF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.
authors.affiliation: Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; Department of Cardiology, the First People's Hospital of Xiaoshan, Hangzhou 311200, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Cheng
authors.forename: Yin-yin
authors.initials: YY
authors.lastname: Dai
authors.forename: Ru-hong
authors.initials: RH
authors.lastname: Jiang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.forename: Ya-xun
authors.initials: YX
authors.lastname: Sun
authors.forename: Jian-wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Zu-wen
authors.initials: ZW
authors.lastname: Zhang
authors.forename: Shi-quan
authors.initials: SQ
authors.lastname: Chen
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
authors.forename: Xia
authors.initials: X
authors.lastname: Sheng
authors.forename: Chen-yang
authors.initials: CY
authors.lastname: Jiang
mesh_terms: D000255:Adenosine Triphosphate; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000517:prevention & control / Q000601:surgery*; D002316:Cardiotonic Agents; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007545:Isoproterenol; D008297:Male; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D000255:Adenosine Triphosphate; D007545:Isoproterenol
keywords: Adenosine triphosphate; Atrial fibrillation; Non-pulmonary vein foci