Significance of the Intravenous Adenosine Triphosphate for Revealing Arrhythmogenic Foci in Patients with Atrial Fibrillation Undergoing Radiofrequency Catheter Ablation
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概要
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<B>Background:</B> Intravenous adenosine can induce atrial fibrillation (AF). However, the role of adenosine for revealing arrhythmogenic foci in patients undergoing radiofrequency ablation is not determined. <B>Method and Results:</B> In 75 patients undergoing pulmonary vein (PV) isolation for either paroxysmal (N=63) or persistent (N=12) AF, adenosine-triphosphate (ATP: 40 mg) was administered during sinus rhythm to produce asystole for PV venography. We determined the incidence and origin of ectopic beats emerged after intravenous ATP utilizing simultaneous recording of the left and right superior PVs, left inferior PV, coronary sinus, right atrial free wall, septum and superior vena cava. Repetitive beats initiating AF (RBAF, 29 (39%) patients) or single to triplet of premature beats (SPB, 57 (76%) patients) were induced within 1 minute after injection. The origin of 22/29 (76%) RBAF and 37/111 (33%) SPB emerged from PVs. The AF free rate after 1.3±0.5 sessions in patients with RBAF and SPB from the PV only was 96% and 94%, respectively, and those in patients with extra-PV RBAF and extra-PV SPB was 57% (P=0.15 vs. PV RBAF) and 78% (P=0.35 vs. PV SPB), respectively. <B>Conclusion:</B> Intravenous ATP quickly reveals arrhythmogenic foci. Induction of extra-PV RBAF predicts poorer outcome after PVI.
著者
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Miyauchi Yasushi
Department of Cardiology, Nippon Medical School
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Yamamoto Teppei
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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Horie Tsutomu
Department Of Cardiology Tamanagayama Hospital Nippon Medical School
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Murata Hiroshige
Department Of Medicine Nippon Medical School
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Hayashi Hiroshi
Department of Biomolecular Science, Faculty of Science, Toho University
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Mizuno Kyoichi
Department Of 1st Internal Medicine Nippon Medical School
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Katoh Takao
Department Of Cardiovascular Medicine Hyogo Prefectural Amagasaki Hospital
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TAKAHASHI Kenta
Department of Pathology, Laboratory of Cancer Research, Hokkaido University Graduate School of Medicine
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Tsuboi Ippei
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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Uetake Shunsuke
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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Nakatsuji Ayano
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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Katoh Takao
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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Hayashi Meiso
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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Hayashi Meiso
Department of Cardiology, Nippon Medical School
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Miyauchi Yasushi
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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Murata Hiroshige
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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Murata Hiroshige
Department of Intensive and Cardiovascular Care Unit, Nippon Medical School, Japan
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Takahashi Kenta
Department of Cancer Pathology, Hokkaido University Graduate School of Medicine
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Takahashi Kenta
Department of Internal Medicine, Division of Cardiology, Nippon Medical School
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