Electrophysiological effect of adenosine triphosphate and adenosine on atrial and ventricular action potential duration in humans

Bolus injection of adenosine triphosphate (ATP) or adenosine is widely used clinically for terminating supraventricular tachycardia. However, bolus injection of these drugs has been reported to provoke atrial fibrillation (Afib). The effects of ATP and adenosine on the monophasic action potential duration (MAPD) of atrial and ventricular muscle was investigated, as well as the changes in the spatial distribution of atrial functional refractoriness caused by adenosine. Bolus injection of ATP and adenosine shortened atrial MAPD; no change was observed in the ventricle. Because local f-f intervals during atrial fibrillation correlate with the atrial refractory period, changes in mean f-f intervals in the right atrial appendage, His bundle region, coronary sinus ostium and distal coronary sinus were compared before and after injection of adenosine during induced Afib. Maximal shortening of f-f intervals was observed in the right atrial appendage. Inhomogeneous shortening of atrial refractoriness may account for the Afib following bolus injection of ATP or adenosine.