Key result
Adjunctive ablation of non-PV triggers in persistent AF remains challenging with unclear clinical benefit.
Why the study?
Pulmonary vein isolation has limited success in persistent AF due to frequent non-pulmonary vein triggers, and the clinical outcome of catheter ablation for persistent AF remains unclear.
What are the current ablation strategies and clinical implications of targeting non-pulmonary vein triggers in patients with persistent atrial fibrillation?
What are the current ablation strategies and clinical implications of targeting non-pulmonary vein triggers in patients with persistent atrial fibrillation?
This review highlights the importance of non-pulmonary vein triggers in persistent atrial fibrillation and underscores the need for further clarity on the clinical outcomes of targeting these sites during catheter ablation.
Targeting non-PV triggers warrants caution in persistent AF; leaves open optimal strategies and benefit.
Pulmonary vein isolation is an well-established treatment strategy for atrial fibrillation (AF), and it is especially effective for patients with paroxysmal AF. However, the success rate is limited for patients with persistent AF, because non-pulmonary vein triggers which increase AF recurrence are frequently found in these patients. The major non-pulmonary vein triggers are from the left atrial posterior wall, left atrial appendage, ligament of Marshall, coronary sinus, superior vena cava, and crista terminalis, but other atrial sites can also generate AF triggers. All these sites have been known to contain atrial myocytes with potential arrhythmogenic electrical activity. The prevalence and clinical characteristics of these non-pulmonary vein triggers are well studied; however, the clinical outcome of catheter ablation for persistent AF is still unclear. Here, we reviewed the current ablation strategies for persistent AF and the clinical implications of major non-pulmonary vein triggers.
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Yang et al. (2023) conducted a review in Persistent atrial fibrillation. Catheter ablation of non-pulmonary vein triggers was evaluated. Catheter ablation of non-pulmonary vein triggers in persistent atrial fibrillation remains challenging, and while adjunctive strategies can be performed, their optimal approach and additional clinical benefit remain unclear.
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