title: A case of paroxysmal atrial fibrillation with a non-pulmonary vein trigger identified by intravenous adenosine triphosphate infusion.
abstract: A 54-year-old woman was referred to our institution with frequent chest discomfort and was diagnosed with drug-refractory paroxysmal atrial fibrillation. Radiofrequency catheter ablation (RFCA) was performed using a three-dimensional electroanatomic mapping system. After completion of left and right circumferential pulmonary vein isolation (CPVI), an intravenous bolus of adenosine triphosphate (ATP, 20 mg) was administered to evaluate the electric reconduction between the pulmonary vein (PV) and left atrium (LA). Although no PV-LA reconduction was observed, atrial fibrillation (AF) was reproducibly induced. As the duration of AF was very short (<20 s), no further RFCA to the LA was performed. One month later, the patient presented with frequent atrial tachyarrhythmias (ATs), and RFCA was repeated. Although no electric reconduction was observed in the left- or right-sided PVs, incessant ATs and AF were induced after an intravenous bolus administration of ATP. The earliest atrial activation site initiating ATs was consistently identified from electrodes positioned in the superior vena cava (SVC), and both ATs and AF were no longer inducible after electric isolation of the SVC. ATP-induced PV/non-PV ectopy may be a marker of increased susceptibility to autonomic triggers of AF and could potentially predict recurrent AF after CPVI.
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, 28-1, Minamimachi, Ishidamori, Fushimiku, Kyoto City, Kyoto 601-1495, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, 28-1, Minamimachi, Ishidamori, Fushimiku, Kyoto City, Kyoto 601-1495, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Nishina
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, 28-1, Minamimachi, Ishidamori, Fushimiku, Kyoto City, Kyoto 601-1495, Japan.
authors.forename: Yoshitomi
authors.initials: Y
authors.lastname: Kida
authors.affiliation: Arrhythmia Care Center, Takeda Hospital, Kyoto, Japan.
authors.forename: YeongHwa
authors.initials: Y
authors.lastname: Chun
keywords: Adenosine triphosphate; Atrial fibrillation; Circumferential pulmonary vein isolation; Nonpulmonary vein trigger