Predictors of Non-Pulmonary Vein Ectopic Beats Initiating Paroxysmal Atrial Fibrillation

Lee, Shih Huang; Tai, Ching Tai; Hsieh, Ming Hsiung; Tsao, Hsuan Ming; Lin, Yenn Jiang; Chang, Shih Lin; Huang, Jin Long; Lee, Kun Tai; Chen, Yi Jen; Cheng, Jian; Chen, Shih Ann

doi:10.1016/j.jacc.2005.06.016

Cited by 220 publications

(188 citation statements)

References 24 publications

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“…Although this theory seems reasonable, atrial remodeling may be caused by the effect of alcohol and other multifactorial factors. As our data show in the present study, patients who did not consume alcohol were relatively older, more predominantly women, and they had more structural heart disease and heart failure; these factors have been reported to be associated with non‐PV foci in several studies 29, 30, 31, 32, 33. We believe that these negative effects may exceed the positive effect of avoiding alcohol in these patients.…”

Section: Discussionsupporting

confidence: 61%

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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Section: Discussionsupporting

confidence: 61%

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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“…186,205 However, more recent studies strongly suggest that during long-term sustained AF, one should not expect an increase in the spontaneous release of Ca 2+ from the SR, nor that DADs or triggered activity is involved in AF maintenance or in the progression to stable forms of the arrhythmia. 158,206,207 Subsequent to recognition of the importance of the PVs, a variety of sites other than the PVs have been shown to potentially harbor AF-maintaining sources, 208 but the critical importance of the PVs has withstood the test of time.…”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 99%

“…96,197,208,257,530,531,532,533,534 The prevalence of non-PV triggers in different studies varies with the specific definition adopted, which ranges from repetitive atrial premature depolarizations without definitive AF initiation 532,533 to reproducible sustained AF triggering. 534 Supraventricular tachycardias, such as AV nodal reentry or accessory pathway-mediated AV reciprocating tachycardia, can also be identified in up to 4% of unselected patients referred for AF ablation and can serve as a triggering mechanism for AF.…”

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

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2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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1,468

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“…[69][70][71][72][73][74] These triggers may originate from the superior vena cava, coronary sinus, interatrial septum, crista terminalis, Eustachian ridge, inferior mitral annulus, atrial appendages, persistent left superior vena cava and ligament of Marshall. When present, non-PV triggers have been associated with AF recurrence and a worse outcome after ablation.…”

Section: Isoproterenolmentioning

confidence: 99%

Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, occurring in approximately 2 % of the general population.1-3 A progressive increase in both the prevalence and incidence of AF has been demonstrated in recent years, defining AF as a major economic and public health issue. 1 The identification of sites of AF initiation and/or maintenance within the pulmonary veins (PVs) has led to the development of percutaneous procedures to electrically isolate the PVs from the left atrium (LA). 4 Large observational studies and multiple randomised-controlled trials have demonstrated that catheter ablation is universally superior to anti-arrhythmic drugs (AADs) for the maintenance of sinus rhythm (66-89 % versus 9-58 %, respectively) and results in a greater improvement in arrhythmia-related symptoms, exercise capacity and quality of life.1,2,5-8 As a result, catheter ablation has become the 'standard of care' for the maintenance of sinus rhythm in symptomatic patients in whom drugs are ineffective or poorly tolerated.While the results of ablation are unequivocally superior to medical therapy, they are unfortunately not flawless: approximately 30 % of paroxysmal AF patients will experience arrhythmia recurrence after a single ablation procedure.8 As most recurrences are in association with PV reconnection or as a result of non-PV triggers, several pharmacological challenges have been proposed to improve outcomes. [9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures. Pathophysiology of Atrial Fibrillation and Atrial Fibrillation Catheter AblationDespite decades of progress, there is no comprehensive pathophysiological explanation of AF. Early hypotheses postulated that AF resulted from the co-existence of multiple independent wavelets propagating randomly throughout the left and right atria (the 'multiple wavelet hypothesis'). 13,14 This hypothesis suggested that as long as the atria had a sufficient electrical mass, and an adequately short refractory period, AF could be initiated and indefinitely perpetuated. 15 Based on this theory, the early surgical interventions for AF were designed to reduce the excitable mass of atrial tissue by compartmentalising the atria into smaller regions incapable of sustaining a critical number of circulating wavelets. 16 Unfortunately this strategy has proved to be of limited efficacy and has been associated with a substantial risk of major complications. 17In the late 1990s, Haïssaguerre and colleagues demonstrated that AF is a triggered arrhythmia initiated by rapid repetitive discharges, predominantly from the proximal aspect of the PVs. 4 This discovery led to the development of percutaneous procedures to directly eliminate spontaneous focal ectopic activity within the PVs. However, early AF recurrences from the targeted and other nontargeted PVs led to modification of the ablation strategy to electrically isolate all of the PV...

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Predictors of Non-Pulmonary Vein Ectopic Beats Initiating Paroxysmal Atrial Fibrillation

Abstract: The location of non-PV ectopic beats initiating PAF can be predicted by both gender and left atrial enlargement.

Cited by 220 publications

References 24 publications

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

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

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Pharmacological Tests in Atrial Fibrillation Ablation

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