Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome

Inamura, Yukihiro; Nitta, Junichi; Inaba, Osamu; Satô, Akira; Tomomasa, Takeshi; Murata, Kazuya; Ikenouchi, Takashi; Kono, Toru; Matsumura, Yutaka; Takahashi, Yoshihide; Goya, Masahiko; Sasano, Tetsuo

doi:10.1016/j.ijcha.2021.100717

Cited by 17 publications

(20 citation statements)

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“…The non-PV foci induction from the LA was higher in the CB group than in the RF group, which may be reflected by the potentially larger isolation area of the LA in RF ablation (PVI plus LA posterior isolation) [7] . Generally, non-PV triggers were observed in 10%–30% of PAF patients, more frequently in non-PAF, female patients, or patients with low BMI [6] , [16] , [27] , [28] . In this study, patients who were induced non-PV triggers after PVI and performed additional non-PV ablation have a higher atrial tachycardia recurrence rate than those without induced non-PV triggers ( Table4 ).…”

Section: Discussionmentioning

confidence: 98%

Optimal single procedure strategy of pulmonary vein isolation with cryoballoon or radiofrequency and non-pulmonary vein triggers ablation for non-paroxysmal atrial fibrillation

Nitta

Inaba

et al. 2022

IJC Heart & Vasculature

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Section: Discussionmentioning

confidence: 98%

Optimal single procedure strategy of pulmonary vein isolation with cryoballoon or radiofrequency and non-pulmonary vein triggers ablation for non-paroxysmal atrial fibrillation

Nitta

Inaba

et al. 2022

IJC Heart & Vasculature

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“…influenced by the successful elimination of IRAF triggers. The importance of non-PV triggers has also been reported after catheter ablation [15,16]. Kurotobi et al [17] reported that the incidence of non-PV foci, number of non-PV foci, incidence of foci in the right atria, and incidence of multiple foci were significantly higher in persistent than in paroxysmal AF.…”

Section: Plos Onementioning

confidence: 89%

Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation

et al. 2021

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Background Although long sinus arrest is occasionally observed during atrial fibrillation (AF) catheter ablation when the fibrillation was terminated, its meaning and prognosis have not yet been clearly elucidated. We hypothesized that sinus node recovery time (SNRT) after termination of AF (time from termination of AF to the earliest sinus node activation) could reflect the extent of atrial remodeling, influencing the formation of non-pulmonary vein (non-PV) triggers and post-ablation outcomes. Method The participants were 157 consecutive patients with persistent AF (male: 77.1%, age: 63.3±11.2 years) who underwent catheter ablation. We recorded SNRT after terminating AF by radiofrequency delivery or electrical cardioversion during the first ablation and evaluated the relationships between SNRT and atrial tachyarrhythmia recurrence and between SNRT and non-PV triggers after repeat ablation. Results Forty-five patients (28.7%) experienced recurrence of atrial tachyarrhythmias. Patients with recurrence had longer SNRTs (1738 ms vs. 1394 ms, p = 0.012). In the multivariate logistic regression analysis, only SNRT ≥2128ms was a significant independent predictor of clinical AF recurrence (hazard ratio 7.48; 95% confidence interval 2.94–19.00; P<0.001). Kaplan–Meier estimator showed that the recurrence-free rate was significantly lower if ≥ 2128ms (log-rank, p<0.001). Thirty-five patients (77.8%) underwent a second ablation. Although there was no difference in the rate of pulmonary vein reconnections (78.6% vs. 71.4%, p = 0.712), non-PV triggers were observed more frequently in the longer SNRT group (57.1% vs. 14.3%, p = 0.012). Conclusions Patients with a prolonged SNRT had a higher prevalence of AF recurrence after the first ablation and higher inducibility of non-PV triggers. Measuring SNRT might be used for the stratification of patients with persistent AF.

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“…In the first place, individuals studied were persistent AF patients while the present study employed exclusively paroxysmal AF patients. As persistent AF shows more complicated atrial substrate and often presents AF drivers outside of PVs, efficiency of CA of PVs is notably lower with respect to success rates in paroxysmal AF patients [ 19 , 80 ]. Secondly, the procedure consisted of CA of PVs, CA of CFAEs and linear CA of LA.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the effect of CA on additional non-PV triggers remains quite controversial. Evidence shows that additional ablation of these sites offers little or no improved results with respect to single PVs ablation [ 17 , 18 , 19 ]. It remains unclear, however, whether failure of additional CA applications to provide significant improvement in termination of AF stems from the incapacity of CA on sites other than PVs to terminate AF or from a vague and unclear definition of areas in need of ablation due to highly complex EGMs, thus highlighting the need for more reliable algorithms able to properly evaluate the atrial substrate [ 6 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Dissimilar Impact in Atrial Substrate Modificationof Left and Right Pulmonary Veins Isolation after Catheter Ablation of Paroxysmal Atrial Fibrillation

Vraka

Bertomeu-González

Fácila

et al. 2022

JPM

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Since the discovery of pulmonary veins (PVs) as foci of atrial fibrillation (AF), the commonest cardiac arrhythmia, investigation revolves around PVs catheter ablation (CA) results. Notwithstanding, CA process itself is rather neglected. We aim to decompose crucial CA steps: coronary sinus (CS) catheterization and the impact of left and right PVs isolation (LPVI, RPVI), separately. We recruited 40 paroxysmal AF patients undergoing first-time CA and obtained five-minute lead II and bipolar CS recordings during sinus rhythm (SR) before CA (B), after LPVI (L) and after RPVI (R). Among others, duration, amplitude and atrial-rate variability (ARV) were calculated for P-waves and CS local activation waves (LAWs). LAWs features were compared among CS channels for reliability analysis. P-waves and LAWs features were compared after each ablation step (B, L, R). CS channels: amplitude and area were different between distal/medial (p≤0.0014) and distal/mid-proximal channels (p≤0.0025). Medial and distal showed the most and least coherent values, respectively. Correlation was higher in proximal (≥93%) than distal (≤91%) areas. P-waves: duration was significantly shortened after LPVI (after L: p=0.0012, −13.30%). LAWs: insignificant variations. ARV modification was more prominent in LAWs (L: >+73.12%, p≤0.0480, R: <−33.94%, p≤0.0642). Medial/mid-proximal channels are recommended during SR. CS LAWs are not significantly affected by CA but they describe more precisely CA-induced ARV modifications. LPVI provokes the highest impact in paroxysmal AF CA, significantly modifying P-wave duration.

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Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome

Cited by 17 publications

References 20 publications

Optimal single procedure strategy of pulmonary vein isolation with cryoballoon or radiofrequency and non-pulmonary vein triggers ablation for non-paroxysmal atrial fibrillation

Optimal single procedure strategy of pulmonary vein isolation with cryoballoon or radiofrequency and non-pulmonary vein triggers ablation for non-paroxysmal atrial fibrillation

Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation

The Dissimilar Impact in Atrial Substrate Modificationof Left and Right Pulmonary Veins Isolation after Catheter Ablation of Paroxysmal Atrial Fibrillation

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