Importance of nonpulmonary vein foci in catheter ablation for paroxysmal atrial fibrillation

Hayashi, Kentarō; An, Yoshimori; Nagashima, Michio; Hiroshima, Kenzo; Ohe, Masatsugu; Makihara, Yu; Yamashita, Kennosuke; Yamazato, Schoichiro; Fukunaga, Masato; Sonoda, Kenzo; Ando, Kenji; Goya, Masahiko

doi:10.1016/j.hrthm.2015.05.003

Cited by 107 publications

(99 citation statements)

References 18 publications

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“…17, 19 We previously reported that the success rate of PAF ablation can be improved if all non-PV foci are detected and eliminated, although the mapping of all non-PV foci is technically challenging, even with the use of multiple procedures. 18 In the present study, at least 9.3% of patients had multiple non-PV foci in the SSS group, indicating that efforts to identify and ablate non-PV foci in patients with SSS, despite the presence of multiple non-PV foci or low reproducibility, may reduce the risk of subsequent AF recurrence.…”

Section: Discussionmentioning

confidence: 48%

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Hayashi

Fukunaga

Yamaji

et al. 2016

Circ J

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Section: Discussionmentioning

confidence: 48%

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Hayashi

Fukunaga

Yamaji

et al. 2016

Circ J

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“…42 Catheter ablation of these non-PV triggers added to PV isolation was shown to improve the outcome in paroxysmal AF. 43 Localization of non-PV AF triggers, however, is still challenging, particularly when multifocal non-PV triggers are targeted. Santangeli et al reported that non-PV triggers were elicited in 11% of AF patients and these triggers were typically clustered in discrete anatomic regions such as the inferior mitral annulus, posterior LA, interatrial septum, particularly at the fossa ovalis/limbus region, crista terminalis, Eustachian ridge, coronary sinus (CS), and the SVC (Figure 5).…”

Section: Ablation Of Non-pv Triggersmentioning

confidence: 99%

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Okamatsu

Okumura

2018

Circ J

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ablation lesion. These novel technologies will promisingly bring new strategies of ablation and enhanced effectiveness and safety. Here, we review the previous reports on catheter ablation for persistent AF, and then introduce possible strategies for persistent AF ablation under concomitant use of the new technologies. Previous Reports on Ablation Strategies for Persistent AFPrior common procedures for persistent AF ablation include creation of linear lesions in the left atrium (LA) and focal ablation targeting complex fractionated electrograms (CFAEs Since the landmark study of Haïssaguerre et al demonstrating that the triggers initiating atrial fibrillation (AF) originate from the pulmonary veins (PVs), catheter ablation targeting PV has become an established strategy for paroxysmal AF. 1 The recognition that AF trigger sites were located within the PV antrum in the majority of cases led to extended, circumferential PV antrum isolation (PVAI) as an ablation procedure for AF. The recurrence of atrial tachyarrhythmias was reported to be significantly less in patients with large isolation areas around both ipsilateral PVs than in those with segmental PV isolation. 2 A recent study showed that, in patients with paroxysmal AF undergoing extended PVAI, the rate of late recurrence was lower than that previously reported with segmental or less extensive antral isolation. 3 Today, PVAI is the cornerstone of catheter-based therapies for paroxysmal AF. However, the success rates of catheter ablation in cases of persistent AF are significantly lower than those for paroxysmal AF. Progressive atrial remodeling in persistent AF has been regarded as a reason for the low efficacy of the treatment in persistent AF. Therefore, additional ablation strategies for modifying and eliminating the AF-sustaining atrial substrate have been developed and challenged.Recently, there has been technological progress in both 3D mapping systems and ablation catheters, which enable us to create precise high-resolution mapping and a durable Pulmonary vein (PV) antrum isolation (PVAI) is effective in treating paroxysmal atrial fibrillation (AF) but is less so for persistent AF. A recent randomized study on the ablation strategies for persistent AF demonstrated that 2 common atrial substrate modifications, creation of linear lesions in the left atrium and ablation of complex fractionated electrogram sites, in addition to PVAI did not improve the outcome compared with stand-alone PVAI, suggesting the necessity of a more individualized, selective approach to persistent AF. There are emerging technologies, including high-resolution mapping with the use of multi-electrode catheter and auto mapping system and contact force (CF) guide ablation; the former allows rapid and accurate confirmation of the completeness of PVAI, and the latter enhances the achievement of durable ablation lesions more securely. Ablation for fibrotic area(s) has been proposed as a new approach for substrate modification, and high-resolution mapping is useful to define the area ...

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“…[69][70][71][72][73][74][81][82][83] Non-PV triggerablation protocols generally involve burst-pacing protocols with isoproterenol infusion to induce the triggers, followed by mapping patients with long-standing persistent AF). 33,84,85 This incidence seems to increase with age, worse atrial substrate and in the presence of cardiomyopathy.…”

Section: Clinical Valuementioning

confidence: 99%

“…Most studies considered repetitive premature atrial contraction as the target for ablation. 9,33,[81][82][83][84][85][86][87] Several repetitive premature atrial contractions, however, will never induce AF. As such, an increased success rate has been achieved when targeting only the premature atrial contractions that induce AF.…”

Section: Clinical Valuementioning

confidence: 99%

Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, occurring in approximately 2 % of the general population.1-3 A progressive increase in both the prevalence and incidence of AF has been demonstrated in recent years, defining AF as a major economic and public health issue. 1 The identification of sites of AF initiation and/or maintenance within the pulmonary veins (PVs) has led to the development of percutaneous procedures to electrically isolate the PVs from the left atrium (LA). 4 Large observational studies and multiple randomised-controlled trials have demonstrated that catheter ablation is universally superior to anti-arrhythmic drugs (AADs) for the maintenance of sinus rhythm (66-89 % versus 9-58 %, respectively) and results in a greater improvement in arrhythmia-related symptoms, exercise capacity and quality of life.1,2,5-8 As a result, catheter ablation has become the 'standard of care' for the maintenance of sinus rhythm in symptomatic patients in whom drugs are ineffective or poorly tolerated.While the results of ablation are unequivocally superior to medical therapy, they are unfortunately not flawless: approximately 30 % of paroxysmal AF patients will experience arrhythmia recurrence after a single ablation procedure.8 As most recurrences are in association with PV reconnection or as a result of non-PV triggers, several pharmacological challenges have been proposed to improve outcomes. [9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures. Pathophysiology of Atrial Fibrillation and Atrial Fibrillation Catheter AblationDespite decades of progress, there is no comprehensive pathophysiological explanation of AF. Early hypotheses postulated that AF resulted from the co-existence of multiple independent wavelets propagating randomly throughout the left and right atria (the 'multiple wavelet hypothesis'). 13,14 This hypothesis suggested that as long as the atria had a sufficient electrical mass, and an adequately short refractory period, AF could be initiated and indefinitely perpetuated. 15 Based on this theory, the early surgical interventions for AF were designed to reduce the excitable mass of atrial tissue by compartmentalising the atria into smaller regions incapable of sustaining a critical number of circulating wavelets. 16 Unfortunately this strategy has proved to be of limited efficacy and has been associated with a substantial risk of major complications. 17In the late 1990s, Haïssaguerre and colleagues demonstrated that AF is a triggered arrhythmia initiated by rapid repetitive discharges, predominantly from the proximal aspect of the PVs. 4 This discovery led to the development of percutaneous procedures to directly eliminate spontaneous focal ectopic activity within the PVs. However, early AF recurrences from the targeted and other nontargeted PVs led to modification of the ablation strategy to electrically isolate all of the PV...

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Importance of nonpulmonary vein foci in catheter ablation for paroxysmal atrial fibrillation

Abstract: Success rates can be improved for PAF ablation if non-PV foci are detected and eliminated.

Cited by 107 publications

References 18 publications

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Pharmacological Tests in Atrial Fibrillation Ablation

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Importance of nonpulmonary vein foci in catheter ablation for paroxysmal atrial fibrillation

Abstract: Success rates can be improved for PAF ablation if non-PV foci are detected and eliminated.

Cited by 107 publications

References 18 publications

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome – Important Role of Non-Pulmonary Vein Foci –

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome – Important Role of Non-Pulmonary Vein Foci –

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation ― Impact of Progress in the Mapping and Ablation Technologies ―

Pharmacological Tests in Atrial Fibrillation Ablation

Contact Info

Product

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Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―