Introduction
The pulmonary veins (PV) are the most frequent trigger source of atrial fibrillation (AF) and PV isolation is the cornerstone of catheter ablation for AF.1 Non-PV foci are occasionally identified during the ablation procedure, and isoproterenol (ISP) are commonly utilized to elicit the AF triggers.2
An intravenous injection of adenosine triphosphate (ATP) or adenosine has been used to unmask dormant conduction following isolation of pulmonary veins (PVs).3 It has also been known that intravenous ATP may induce AF.4 ATP produced the same cardiac effects and share similar receptor-effector coupling systems with acetylcholine.5 ATP injection enhances parasympathetic activity followed by responsive sympathetic hyperactivity. However, the association between ATP injection and hyperactivity of the intrinsic cardiac autonomic nervous system, known as ganglionated plexus (GP) were not well-understood.
In this retrospective study, we describe a series of patients with non-PV trigger site provoked by ATP injection, and assess the feasibility of GP ablation.