Catheter Ablation of Paroxysmal Atrial Fibrillation Initiated by Non–Pulmonary Vein Ectopy

Wang, Lin; Tai, Ching Tai; Hsieh, Ming Hsiung; Tsai, Chia Fen; Lin, Yung Kuo; Tsao, Hsuan Ming; Huang, Jin Long; Yu, Wen Chung; Yang, Sung‐Pei; Ding, Yu An; Chang, Mau Song; Chen, Shih Ann

doi:10.1161/01.cir.0000074206.52056.2d

Cited by 654 publications

(337 citation statements)

References 38 publications

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“…20,21,30,31 Among these common sites of non-PV triggers, the SVC accounted for 76% (28/37) of cases in our study, which was much higher than the range of 6% to 12% reported previously. 22,24,26 The higher incidence of SVC trigger observed in our study might be related to ethnic differences from previous non-Asian studies or our use of a broad definition of non-PV trigger.…”

Section: Prevalence Of Non-pv Triggerscontrasting

confidence: 72%

“…16,[19][20][21][22][23][24][25][26][27][28] Noninducibility of AF achieved by additional ablation after PVI is associated with lower AF recurrence compared with PVI alone. 23,24,28 However, Leong-Sit 29 et al reported that noninducibility of any atrial tachyarrhythmia is not predictive of clinical recurrence at a 1-year follow-up.…”

Section: Need For An Additional Procedural End Point Beyond Pvimentioning

confidence: 99%

“…Thus, further study is warranted to more effectively identify triggers in patients with PAF. 1,21,30,31 Fourth, inducible atrial tachyarrhythmia was defined with a minimum duration of 5 minutes, although other definitions have been used in previous studies. 35,36 A final limitation of this study was that the PVI-only group was not included as a control to determine whether the elimination of non-PV triggers evoked in 10% of patients led to better long-term outcome compared with testing inducibility post-PVI.…”

Section: Study Limitationsmentioning

confidence: 99%

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Long-Term Clinical Comparison of Procedural End Points After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Lee

Roh

Baek

et al. 2018

Circ: Arrhythmia and Electrophysiology

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BACKGROUND:Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. METHODS AND RESULTS:A total of 500 patients (mean age, 55.7±11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups.CONCLUSIONS: Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.

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Section: Prevalence Of Non-pv Triggerscontrasting

confidence: 72%

Section: Need For An Additional Procedural End Point Beyond Pvimentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

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Long-Term Clinical Comparison of Procedural End Points After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Lee

Roh

Baek

et al. 2018

Circ: Arrhythmia and Electrophysiology

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“…Isoproterenol (5–20 μg/min) was injected intravenously before the procedure was completed. If sustained or nonsustained AF was reproducibly induced from non‐PV foci, they were focally ablated 16. When non‐PV foci were located in the superior vena cava, the superior vena cava was electrically isolated 17.…”

Section: Methodsmentioning

confidence: 99%

Impact of Alcohol Consumption on the Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation

Takigawa

Takahashi

Kuwahara

et al. 2016

JAHA

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BackgroundAlthough several studies have reported an association between atrial fibrillation (AF) and alcohol, the impact of alcohol consumption on the outcome after catheter ablation (CA) for AF has not been discussed. We aimed to elucidate the effect of alcohol consumption on the outcome of CA for paroxysmal AF.Methods and ResultsWe examined 1361 consecutive patients with paroxysmal AF (mean age, 61±11 years, 334 women) who underwent CA, including 623 (45.8%) patients who consumed alcohol. The clinical characteristics and outcomes of CA were compared between patients who did and did not consume alcohol. No significant differences were seen in the left atrial size, duration of AF history, and incidence of nonpulmonary vein foci between 2 groups (P=NS). Although the AF recurrence‐free rate after the initial CA was higher in patients who did not consume alcohol (261/623 [41.9%] versus 252/738 [34.1%]; mean follow‐up, 44.4±30.7 months; P=0.003), the outcome after the final CA was similar between 2 groups (patients who consumed alcohol: 111/628 [17.7%] versus patients who did not consume alcohol: 138/738 [18.7%]; mean follow‐up, 53.1±25.8 months; P=0.67). The frequency (hazard ratio 1.07 per 1 day/week increase, CI 1.00–1.15, P=0.04) of alcohol consumption was significantly associated with AF recurrence after CA.ConclusionsThe frequency of alcohol consumption may be associated with AF recurrence after the initial CA for paroxysmal AF, but it may not affect the outcome after the final CA.

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“…The concept that the onset and maintenance of AF require both a trigger and a substrate was well accepted. Ectopic foci occurring in muscular sleeves of PV or vena caval junctions were considered as critical AF triggers (Haïssaguerre et al, 1998;Lin et al, 2003). Selfperpetuation process of AF including structural (atrial fibrosis, dilation, etc.)…”

Section: Incidence Of Af Before and After Cpvimentioning

confidence: 99%

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

Cao

Dai

Jiang

et al. 2014

J. Zhejiang Univ. Sci. B

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Objective: To 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). Methods: In 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. Results: Before 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). Conclusions: ATP+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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Catheter Ablation of Paroxysmal Atrial Fibrillation Initiated by Non–Pulmonary Vein Ectopy

Cited by 654 publications

References 38 publications

Long-Term Clinical Comparison of Procedural End Points After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Long-Term Clinical Comparison of Procedural End Points After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Impact of Alcohol Consumption on the Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

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