Association between the locations of non-pulmonary vein triggers and ablation outcomes in repeat procedures after cryoballoon ablation of paroxysmal atrial fibrillation
- 6 November 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Interventional Cardiac Electrophysiology
- Vol. 62 (2), 381-389
- https://doi.org/10.1007/s10840-020-00913-9
Abstract
Purpose We examined the characteristics of non-pulmonary vein (PV) triggers in repeat ablation after cryoballoon ablation for paroxysmal atrial fibrillation (PAF). Methods This study evaluated 119 patients undergoing a second ablation procedure for recurrent atrial tachyarrhythmia (ATA) after cryoballoon PV isolation (CB-PVI) for PAF. Results Fifty-three of 119 (45%) patients had PV reconnection. All reconnected PVs were isolated. No non-PV triggers were elicited in 42/119 (35%) patients (NNPV group). In 77/119 (65%) patients, 139 isoproterenol-induced non-PV triggers, including 45 triggers that initiated AF, were identified. Non-PV triggers initiating AF were observed at the superior vena cava (SVC), left atrial posterior wall (LAPW) including the PV antra, interatrial septum, right atrium, left atrial appendage/mitral anulus, and coronary sinus in 14 (12%), 10 (8%), 8 (7%), 7 (6%), 4 (3%), and 2 (2%) patients, respectively. Non-PV triggers originated from only the SVC and/or LAPW including the PV antra, and the SVC and/or LAPW was isolated in 18/119 (15%) patients (SVC/LAPW group). Non-PV triggers originating from other sites were focally ablated in 59/119 (50%) patients (OS group). During a median 461 days of follow-up, 39/42 (93%), 17/18 (94%), and 38/59 (64%) patients in the NNPV, SVC/LAPW, and OS groups, respectively, remained ATA recurrence-free. The recurrence rate was higher in the OS group than in the NNPV (P = 0.005) or SVC/LAPW groups (P = 0.042). Conclusions Over half of patients had non-PV triggers at subsequent ablation after CB-PVI. Non-PV triggers from the SVC/LAPW can be eliminated more successfully than triggers from other sites.Keywords
This publication has 23 references indexed in Scilit:
- Importance of non–pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fractionHeart Rhythm, 2015
- Importance of nonpulmonary vein foci in catheter ablation for paroxysmal atrial fibrillationHeart Rhythm, 2015
- Durability of Pulmonary Vein Isolation with Cryoballoon Ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) StudyJournal of Cardiovascular Electrophysiology, 2015
- Impact of Non‐Pulmonary Vein Foci on the Outcome of the Second Session of Catheter Ablation for Paroxysmal Atrial FibrillationJournal of Cardiovascular Electrophysiology, 2015
- Administration of Isoproterenol and Adenosine to Guide Supplemental Ablation After Pulmonary Vein Antrum IsolationJournal of Cardiovascular Electrophysiology, 2013
- Long‐Term Outcome of Catheter Ablation in Patients with Atrial Fibrillation Originating from Nonpulmonary Vein EctopyJournal of Cardiovascular Electrophysiology, 2012
- Small or Large Isolation Areas Around the Pulmonary Veins for the Treatment of Atrial Fibrillation?Circulation, 2007
- Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome†European Heart Journal, 2007
- Catheter Ablation of Paroxysmal Atrial Fibrillation Initiated by Non–Pulmonary Vein EctopyCirculation, 2003
- Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary VeinsThe New England Journal of Medicine, 1998