Impact of diagnosis‐to‐ablation time on non‐pulmonary vein triggers and ablation outcomes in persistent atrial fibrillation

Abstract

Introduction: Non-pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosisto-ablation time (DAT) on non-PV triggers in persistent atrial fibrillation is unknown.Methods and Results: This observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non-PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non-PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow-up of 770 days, the ATA recurrence-free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year,

Risk and benefit of extrapulmonary vein ablation in atrial fibrillation

“…Among 2118 de-novo ablation and 227 repeat ablations for atrial fibrillation, Kim et al [36] reported that 11.7 and 28.6% of patients were found to have extrapulmonary triggers, respectively. Factors associated with the existence of extrapulmonary triggers include age, left atrial volume, female sex, presence of diabetes, higher parasympathetic nerve activity, and longer diagnosis to ablation time [36,37]. On the premise of risk control, elimination of these triggers could be rewarding.…”

Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation

“…While linear-based ablations including posterior wall isolation are uniform procedures, CFAE ablation, LVA ablation and non-PV trigger ablation may be unique treatments for each patient. Recently, it has been reported that elimination of non-PV triggers is related to favorable outcomes in persistent AF as well as in paroxysmal AF [ 11 – 15 ]. Although the impact of non-PV triggers in AF has become more evident, non-PV trigger ablation has not been standardized as an additional procedure to PVI, partly because of the need of skilled catheter technique of non-PV trigger mapping [ 16 ].…”

Ablação por Cateter como Terapia de Primeira Linha no Tratamento da Fibrilação Atrial – Devemos Sempre Indicar?

“…8,9 Similarly, the shorter time from the first diagnosis of persistent AF to ablation reduces the occurrence of extrapulmonary vein triggers and recurrence of atrial tachyarrhythmias. 10 In this journal, Carddoso et al 11 presented an elegant systematic review and meta-analysis on the superiority of catheter ablation as first-line therapy over AADs for AF.…”