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Title: Importance of nonpulmonary vein foci in catheter ablation for paroxysmal atrial fibrillation.
Author: Hayashi K, An Y, Nagashima M, Hiroshima K, Ohe M, Makihara Y, Yamashita K, Yamazato S, Fukunaga M, Sonoda K, Ando K, Goya M.
Journal: Heart Rhythm; 2015 Sep; 12(9):1918-24. PubMed ID: 25962801.
Abstract:
BACKGROUND: Pulmonary vein (PV) isolation is an established treatment strategy for paroxysmal atrial fibrillation (PAF). However, the recurrence rate of PAF is 8% to 37%, despite repeated procedures, and the catheter ablation strategy for PAF with non-PV foci is unclear. OBJECTIVE: The purpose of this study was to assess the PAF ablation strategy for non-PV foci. METHODS: The study included 304 consecutive patients undergoing PAF ablation (209 males, age 63.0 ± 10.4 years) divided into 3 groups: group 1 (245 patients) with no inducible non-PV foci; group 2 (34 patients) with atrial fibrillation (AF) originating from non-PV foci and all the foci successfully ablated; and group 3 (25 patients) with AF originating from non-PV triggers, but without all foci being ablated or with persistently inducible AF. RESULTS: Mean follow-up period was 26.9 ± 11.8 months, and AF recurrence rates since the last procedure were 9.8%, 8.8%, and 68.0% in groups 1, 2, and 3, respectively. There was no statistically significant difference in recurrence rate between groups 1 and 2 (P = .89); however, there were statistically significant differences between groups 3 and 1 (P <.0001) and groups 3 and 2 (P <.0001). The patients in group 2 had an AF-free outcome to equivalent to those who had PV foci in group 1 (P = .83). CONCLUSION: Success rates can be improved for PAF ablation if non-PV foci are detected and eliminated.

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