Clarifying the Definition of Non–Pulmonary Vein Triggers of Atrial Fibrillation

Marchlinski, Francis E.; Tschabrunn, Cory M.; Kubala, Maciej

doi:10.1016/j.jacep.2019.08.004

Cited by 6 publications

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Continuous observational studies are required to identify char formation, which is rarely observed during HPSD-RFCA and PV stenosis following a Cryo-PVI. 31 The importance of the development and validation of an accurate and reproducible mapping technique for extra-PV foci cannot be overemphasized. 13 To solve the problems with the current ablation technology, pulse-field ablation, HPSD ablation, irrigated radiofrequency balloon ablation, and LASER balloon PVI can be used safely and confidently in the treatment of patients with AF.…”

Section: Future Directionsmentioning

confidence: 99%

Cryoballoon Versus High-Power, Short-Duration Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

Pak

Park

Yang

et al. 2021

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Background: The efficacy of cryoballoon pulmonary vein isolation (Cryo-PVI) is equivalent to that of radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation (AF). We aimed to compare the efficacy and safety profile of Cryo-PVI and high-power, short-duration (HPSD) radiofrequency catheter ablation (RFCA) in patients with AF. Methods: We prospectively randomized 314 patients with paroxysmal AF (men, 71.3%; 59.9±10.9 years old) to either the Cryo-PVI group (n=156) or HPSD-RFCA group (n=158). Cavotricuspid isthmus ablation and linear ablation from the superior vena cava to the right atrial septum in addition to pulmonary vein isolation were carried out in the majority of patients in the HPSD-RFCA group. The primary end point was AF recurrence after a single procedure; secondary end points were the recurrence pattern, cardioversion rate, follow-up heart rate variability, and response to antiarrhythmic drugs. Results: After a mean follow-up of 9.8±5.1 months, the clinical recurrence rate did not significantly differ between the two groups (log-rank P =0.840). The rate of recurrence as atrial tachycardia ( P >0.999), cardioversion ( P =0.999), and 3-month heart rate variability (high frequency; P =0.506) did not significantly differ. During the final follow-up, sinus rhythm was maintained without antiarrhythmic drugs in 70.5% of the Cryo-PVI group and 73.4% of the HPSD-RFCA group ( P =0.567). No significant difference was found in the major complication rate between the two groups (3.8% versus 0.6%; P =0.066), but total procedure time was significantly shorter in the Cryo-PVI group (78.5±20.2 versus 124.5±37.1 minutes; P <0.001). Conclusions: In patients with paroxysmal AF, the Cryo-PVI is an effective rhythm-control strategy with a shorter procedure time compared with the HPSD-RFCA. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03920917.

show abstract

Section: Future Directionsmentioning

confidence: 99%

Cryoballoon Versus High-Power, Short-Duration Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

Pak

Park

Yang

et al. 2021

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…The localization of nonsustained non-PV triggers remains challenging. 10) The P-wave morphology and the intra-atrial multipolar activation pattern and timing can help identify non-PV trigger sites of origin. Kubala et al 11) described the electrophysiological characteristics of 15 major sites of non-PV triggers, but they did not include the NCC in their study.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Characteristics of Atrial Tachycardia From Noncoronary Aortic Cusp During Atrial Fibrillation Catheter Ablation

et al. 2022

View full text Add to dashboard Cite

Author's summary The prevalence of the uncommon atrial tachycardia (AT) originating from the non-coronary cusp (NCC) in patients undergoing atrial fibrillation (AF) ablation were overall 0.08% (0.07% in initial AF ablation cases, and 0.15% in redo cases). The characteristics of NCC ATs uncovered during AF ablation presented shorter tachycardia cycle length and increased P-wave duration compared to that of de novo NCC AT without AF. The AF recurrence rate after pulmonary vein isolation and NCC AT ablation was low without significant procedure related complication such as atrioventricular conduction block.

show abstract

“…Although pulmonary veins are considered the primary source of AF in structurally normal hearts, AF in ACHD may arise from other non–pulmonary vein ectopic foci (“extrapulmonary triggers”), such as the right atrium (RA) and crista terminalis, the left atrial roof/posterior wall, the left atrial appendage, the superior vena cava (right or left persistent), the coronary sinus ostium, the interatrial septum, and the ligament or vein of Marshall. 9 , 10 , 11 , 12 , 13 All these sites have been known to contain atrial myocytes with potential arrhythmogenic electrical activity. 14 According to a large observational study, patients with AF initiating from non–pulmonary vein ectopy are younger and more frequently have nonparoxysmal AF, right atrial enlargement, and biatrial remodeling compared with patients with AF initiating from pulmonary vein triggers only.…”

Section: Pathophysiology and Risk Factors For Af In Achdmentioning

confidence: 99%

Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives

Baroutidou,

Otountzidis,

Papazoglou

et al. 2024

JAHA

View full text Add to dashboard Cite

The increasing prevalence of atrial fibrillation (AF) in adults with congenital heart disease raises significant questions regarding its management. The unique underlying anatomic and physiological background further adds to the difficulty in eliminating the AF burden in these patients. Herein, we provide an overview of the current knowledge on the pathophysiology and risk factors for AF in adult congenital heart disease, with a special focus on the existing challenges in AF ablation. Emerging imaging modalities and ablation techniques might have a role to play. Evidence regarding the safety and efficacy of AF ablation in adult congenital heart disease is summarized, especially for patients with an atrial septal defect, Ebstein anomaly of the tricuspid valve, tetralogy of Fallot, and Fontan circulation. Finally, any remaining gaps in knowledge and potential areas of future research are highlighted.

show abstract

Clarifying the Definition of Non–Pulmonary Vein Triggers of Atrial Fibrillation

Cited by 6 publications

References 12 publications

Cryoballoon Versus High-Power, Short-Duration Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

Cryoballoon Versus High-Power, Short-Duration Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

Prevalence and Characteristics of Atrial Tachycardia From Noncoronary Aortic Cusp During Atrial Fibrillation Catheter Ablation

Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives

Contact Info

Product

Resources

About