Identification of pulmonary vein triggers during de novo catheter ablation for atrial fibrillation predicts better clinical outcomes

Background Pulmonary veins (PVs) are key sources of ectopic activity initiating atrial fibrillation (AF). However, the clinical significance of PV triggers identified during catheter ablation (CA) remains unclear. This study aimed to assess whether the identification of spontaneous PV triggers during de novo CA is associated with long-term clinical outcomes. Methods We retrospectively analyzed 1,420 patients (72.3% male, 59.6±11.4 years) who underwent de novo CA for AF between January 2015 and July 2022. All patients received wide circumferential pulmonary vein isolation (PVI) without substrate modification. PV triggers were identified based on spontaneous or incidentally provoked ectopic activity. Extra-PV trigger ablation was performed at the operator’s discretion. Results PV trigger were identified in 537 patients (37.8%). During a mean follow-up of 28.3±21.3 months, patients with identified PV triggers had lower recurrence of atrial arrhythmia than those without (22.5% vs. 30.7%, P<0.001). In Multivariate Cox regression analysis, PV trigger presence was independently associated with reduced recurrence (Hazard ratio [HR] 0.77, 95% Confidence interval [CI] 0.61-0.97, P=0.027), whereas persistent AF, left atrial (LA) diameter ≥50mm, and extra-PV triggers were associated higher recurrence. Logistic regression showed that PV trigger presence was associated with a LA volume ≤100ml, paroxysmal AF, and left ventricular ejection fraction ≥50%. Conclusion The identification of PV triggers during CA is independently associated with favorable clinical outcomes. This finding suggests that early intervention before advanced structural and electrical remodeling may improve rhythm control by targeting triggers confined to the PVs.