Endocardial mapping and ablation of non-PV foci in patients with recurrent AF after PV isolation resulted in 68% of patients being free of AF without antiarrhythmic treatment at 8 months.
Observational (n=160)
Does endocardial mapping and ablation of non-PV foci improve freedom from AF in patients with recurrent AF after PV isolation?
Non-pulmonary vein foci are present in 24% of patients with recurrent AF after PV isolation, and mapping and ablating these foci can help achieve freedom from AF.
Though the majority of foci triggering atrial fibrillation (AF) have been mapped to the pulmonary veins (PV), recurrence of paroxysmal AF after isolation of all four pulmonary veins indicates the presence of other foci. In a series of 160 consecutive patients who underwent PV ablation, endocardial mapping of AF and ectopy recurring after PV isolation was performed. Thirty-six patients (24%) had a total of 85 non-PV foci; 39 were mapped to the ostia of ablated PVs, 30 to the posterior left atrium (LA), 5 to other parts of the LA, 5 to the right atrium (RA), 4 to the coronary sinus (CS), and 3 to the superior vena cava (SVC) (including one persistent left SVC). Mapping was confirmed by successful ablation. At least 16 foci could not be localized and after a follow-up of 8 +/- 6 months, 68% of patients were free of AF without any antiarrhythmic treatment. The occurrence of non-PV foci correlated with recurrence of AF, perhaps as a correlate of insufficient ostial ablation. These data reinforce the requirement for more proximal disconnection of the PVs by performing ablation within the LA. In patients with non-PV foci that are difficult to map conventionally, the use of surface ECG data, or multielectrode contact or noncontact mapping arrays, or substrate modifying/excluding ablation may be helpful in ablating these foci and therefore eliminating AF.
Shah et al. (Mon,) conducted a observational in Atrial fibrillation (n=160). Endocardial mapping and ablation of non-PV foci was evaluated on Freedom from AF without antiarrhythmic treatment. Endocardial mapping and ablation of non-PV foci in patients with recurrent AF after PV isolation resulted in 68% of patients being free of AF without antiarrhythmic treatment at 8 months.