“…A previous study reported that non‐PV AF triggers from the LA result from degenerated LAs 25 . Furthermore, a recent study from our group analyzed fractionated signal areas in non‐PV localization and reported a link between electrical and structural remodeling in a self‐perpetuating mechanism and maintenance in PEAF 26 …”
Background
The role of nonpulmonary vein (PV) triggers ablation in persistent atrial fibrillation (PEAF) was suggested but it is still under debate.
Objectives
We aimed to assess the effectiveness of non‐PV trigger‐targeted ablation for patients with PEAF.
Methods
Consecutive patients with PEAF undergoing catheter ablation (CA) between January 2015 and April 2017 were enrolled. Isoproterenol plus adenosine challenge was performed to provoke non‐PV triggers. Non‐PV triggers were defined as the trigger beats inducing AF (non‐PV AF triggers) and/or frequent premature contractions (non‐PV PACs) from other than PVs. Three groups were defined: Group 1 (n = 186) without non‐PV triggers; Group 2 (n = 65) with non‐PV triggers that could be completely eliminated with CA; Group 3 (n = 49) with non‐PV triggers still inducible after CA. The primary endpoint was freedom from any atrial tachyarrhythmia (ATa) recurrence.
Results
A total of 300 patients (230 males, age 64 ± 10) were enrolled. The mean follow‐up period was 27 ± 10 months. Freedom from ATa recurrence at 1 and 2 years were significantly lower in Group 3 compared to the other two groups (Group 1; 74.7%, 67.2% vs. Group 2; 75.8%, 68.3% vs. Group 3: 52.1%, 38.6%, p = .0005), irrespective of the type of non‐PV triggers (non‐PV AF triggers vs. non‐PV PACs). On multivariate analysis, unsuccessful elimination of non‐PV triggers was an independent predictor for ATa recurrence (hazard ratio = 1.80, 95% confidence interval = 1.07–2.95, p = .026).
Conclusion
Successful non‐PV triggers elimination can improve the ATa recurrence rate in PEAF ablation. ATa recurrence rate is higher, if non‐PV AF triggers or even non‐PV PACs remain in patients with PEAF.
“…A previous study reported that non‐PV AF triggers from the LA result from degenerated LAs 25 . Furthermore, a recent study from our group analyzed fractionated signal areas in non‐PV localization and reported a link between electrical and structural remodeling in a self‐perpetuating mechanism and maintenance in PEAF 26 …”
Background
The role of nonpulmonary vein (PV) triggers ablation in persistent atrial fibrillation (PEAF) was suggested but it is still under debate.
Objectives
We aimed to assess the effectiveness of non‐PV trigger‐targeted ablation for patients with PEAF.
Methods
Consecutive patients with PEAF undergoing catheter ablation (CA) between January 2015 and April 2017 were enrolled. Isoproterenol plus adenosine challenge was performed to provoke non‐PV triggers. Non‐PV triggers were defined as the trigger beats inducing AF (non‐PV AF triggers) and/or frequent premature contractions (non‐PV PACs) from other than PVs. Three groups were defined: Group 1 (n = 186) without non‐PV triggers; Group 2 (n = 65) with non‐PV triggers that could be completely eliminated with CA; Group 3 (n = 49) with non‐PV triggers still inducible after CA. The primary endpoint was freedom from any atrial tachyarrhythmia (ATa) recurrence.
Results
A total of 300 patients (230 males, age 64 ± 10) were enrolled. The mean follow‐up period was 27 ± 10 months. Freedom from ATa recurrence at 1 and 2 years were significantly lower in Group 3 compared to the other two groups (Group 1; 74.7%, 67.2% vs. Group 2; 75.8%, 68.3% vs. Group 3: 52.1%, 38.6%, p = .0005), irrespective of the type of non‐PV triggers (non‐PV AF triggers vs. non‐PV PACs). On multivariate analysis, unsuccessful elimination of non‐PV triggers was an independent predictor for ATa recurrence (hazard ratio = 1.80, 95% confidence interval = 1.07–2.95, p = .026).
Conclusion
Successful non‐PV triggers elimination can improve the ATa recurrence rate in PEAF ablation. ATa recurrence rate is higher, if non‐PV AF triggers or even non‐PV PACs remain in patients with PEAF.
“…We previously reported FAAM is related to non-PV foci. 6 Therefore, we decided to ablate the FAAM. Figure 1 Voltage map and fractionated signal areas in atrial muscle (FAAM) map.…”
Section: Case Reportmentioning
confidence: 99%
“…We developed a novel visualization tool of the fractionated signal area in the atrial muscle (FAAM) map, which highlights the fractionated signal area using Lumipoint software in the ultra-high-density Rhythmia (Boston Scientific, Marlborough, MA) system and successfully identifies the non-PV foci. 6 Herein, we report a novel ablation strategy, FAAM ablation, which is effective for refractory AF.…”
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“…20, 21 The efficacy of ablation targeting fractionated electrograms during sinus rhythm using an ultrahigh-resolution mapping system has also been proposed. 22 The management of AF based on therapies for upstream factors, which promote atrial degeneration, such as hypertension, diabetes mellitus, and heart failure, will likely benefit as it takes into consideration that the AF substrate extends across the whole atria rather than being localized to specific portions.…”
Section: Af Substrate Extending To the Whole Lamentioning
Methods
PatientsThis observational study enrolled 405 consecutive patients who underwent the initial AF ablation procedure at Kansai Rosai Hospital between August 2017 and August 2019. Patients in whom a voltage map was not obtained due to unstable cardiac rhythm and those whose 3D mapping was not obtained using the CARTO (CARTO ® ; Biosense Webster, Diamond Bar, CA, USA) system were excluded. This study complied with the Declaration of Helsinki.
Catheter ablation has become a mainstream treatment option for atrial fibrillation (AF). Electrical pulmonary vein isolation (PVI) is well established as the cornerstone of AF ablation; 1,2 however, frequent AF recurrence after ablation remains an unsolved problem, with reported 1-year AF recurrence rates of 20-50%. 2-4 The presence of left atrial (LA) low-voltage areas (LVAs) has been reported to be strongly associated with AF recurrence after ablation. 5-7 Nevertheless, several randomized control trials evaluating the efficacy of LVA ablation in addition to PVI reported controversial results, 8-11 which suggested that extra-pulmonary-vein AF substrate does not always localize within LVAs.The purpose of this study was to compare whole LA electrophysiological degeneration between patients with and without localized LVAs, and to explore clinical and map-
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