Reproducible induction of paroxysmal atrial fibrillation originating from the right atrial appendage by adenosine triphosphate

Non-pulmonary vein (non-PV)-origin atrial fibrillation (AF) accounts for approximately 10–30% of all AF cases. Isoproterenol (ISP) is commonly used to induce AF; however, in some cases of non-PV-origin AF, ISP cannot induce AF, while adenosine triphosphate (ATP) may sometimes be effective. ISP-induced AF is more likely to originate from the pulmonary vein (PV) (93%) compared with ATP (50%), whereas ATP-induced non-PV triggers were found to predominantly originate from the right atrium (RA).1 The most common source of ATP-induced AF is the superior vena cava (SVC), whereas the right atrial appendage (RAA) accounts for only 0.3% of non-PV origin AF cases.