• Hui Cheng, Yin-yin Dai, Ru-hong Jiang, Qiang Liu, Ya-xun Sun, Jian-wei Lin, Zu-wen Zhang, Shi-quan Chen, Jun Zhu, Xia Sheng, and Chen-yang Jiang.
• 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.
• J Zhejiang Univ Sci B. 2014 Oct 1; 15 (10): 915-22.

ObjectiveTo 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).MethodsIn 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.ResultsBefore 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).ConclusionsATP+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.

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