Non-pulmonary vein foci were identified in 19.2% of patients undergoing initial catheter ablation for AF, with female gender, low BMI, non-paroxysmal AF, and sick sinus syndrome as predictors.
Cohort (n=2,967)
What are the clinical characteristics and outcomes of patients with atrial fibrillation caused by non-pulmonary vein triggers undergoing catheter ablation?
Non-pulmonary vein triggers are present in nearly 20% of patients undergoing AF ablation and are associated with specific clinical characteristics (female sex, low BMI, non-paroxysmal AF) and higher risk of recurrence depending on location.
BACKGROUND: The clinical characteristics of atrial fibrillation (AF) resulting from non-pulmonary vein (PV) triggers remain unknown. This study aimed to evaluate the clinical characteristics of patients with AF caused by non-PV triggers, localization of non-PV foci, clinical differences, and clinical outcomes after catheter ablation in each AF focus. METHODS: A total of 2967 patients who underwent initial catheter ablation for paroxysmal or persistent AF were examined. After PV isolation, all patients underwent high-dose isoproterenol infusion to assess the existence of non-PV foci. RESULTS: Non-PV foci were identified in 564 patients (19.2%). The localization of successfully ablated non-PV foci in 514 patients were the superior vena cava (SVC: 213 cases), interatrial septum (IAS: 125 cases), coronary sinus (CS: 98 cases), right atrium (RA: 125 cases), left atrium (LA: 114 cases), and unmappable (50 cases). Multivariate analysis revealed that female gender, low body mass index (BMI), non-paroxysmal AF (PAF), and sick sinus syndrome were independent and significant indicators of non-PV foci. In the multivariate analysis of each AF focus, female gender, low BMI, and non-PAF were significant predictors of IAS and CS foci, RA and IAS foci, and CS foci, respectively. In addition, dilatation of the LA was significantly associated with LA foci, whereas RA, LA, IAS, and CS foci were associated with AF recurrence. CONCLUSION: These findings could help to identify patients at a higher risk of AF caused by non-PV triggers and clarify the clinical difference according to the localization of non-PV foci.
Inamura et al. (Thu,) conducted a cohort in Paroxysmal or persistent atrial fibrillation (n=2,967). High-dose isoproterenol infusion after pulmonary vein isolation was evaluated on Identification of non-pulmonary vein foci. Non-pulmonary vein foci were identified in 19.2% of patients undergoing initial catheter ablation for AF, with female gender, low BMI, non-paroxysmal AF, and sick sinus syndrome as predictors.