Pulmonary vein isolation terminated ongoing AF in 92% of patients with only PV foci compared to 29% of those with non-PV foci (P<0.0001), indicating PVI alone may be insufficient.
Observational (n=65)
Does EnSite array-guided ablation of non-pulmonary vein foci improve atrial fibrillation termination and reduce recurrence in patients with paroxysmal atrial fibrillation?
In patients with paroxysmal AF, non-pulmonary vein foci are common and their presence significantly reduces the acute success of standard pulmonary vein isolation, suggesting that PVI should be supplemented with targeted non-PV foci ablation.
Tasa de eventos absoluta: 29% vs 92%
valor p: p=<0.0001
AIMS: Non-pulmonary vein (PV) foci are sometimes difficult to identify and eliminate. The EnSite array (EA) reveals the detailed beat-to-beat virtual activation. This study aimed to characterize non-PV foci using the EA. METHODS AND RESULTS: Sixty-five patients with paroxysmal atrial fibrillation (AF) were included. All had ectopy initiating AF and/or focal atrial tachycardia analysed using the EA. All patients underwent PV isolation (PVI) and additional ablation of non-PV foci if present. The EA revealed 59 PV foci in 48 patients (Group P) and 19 non-PV foci in 17 patients (Group N). In Group N, 12 patients (71%) also had 17 PV foci. The non-PV foci were frequently distributed in the left atrial (LA) roof (n = 5) and superior vena cava (n = 5). Pulmonary vein isolation during on-going AF terminated AF in 34 of 37 in Group P (92%) and 4 of 14 in Group N (29%) patients (P < 0.0001). All non-PV foci were eliminated by an EA-guided ablation. During a 23 ± 10 month follow-up, 11 patients (17%) had AF recurrences, mainly due to LA-PV reconnection. CONCLUSION: Non-PV foci are prevalent in the LA roof and SVC sites, but can originate from other sites as well. When non-PV foci are observed, PVI may be insufficient and should be supplemented with non-PV foci ablation.
Yamaguchi et al. (Fri,) conducted a observational in paroxysmal atrial fibrillation (n=65). EnSite array-guided ablation vs. Patients with only pulmonary vein foci was evaluated on AF termination by pulmonary vein isolation during on-going AF (p=<0.0001). Pulmonary vein isolation terminated ongoing AF in 92% of patients with only PV foci compared to 29% of those with non-PV foci (P<0.0001), indicating PVI alone may be insufficient.