Long‐Term Outcome of Catheter Ablation in Patients with Atrial Fibrillation Originating from Nonpulmonary Vein Ectopy

Chang, Hung‐Yu; Lo, Li‐Wei; Lin, Yenn-Jiang; Chang, Shih‐Lin; Hu, Yu‐Feng; Li, Cheng-Hung; Chao, Tze‐Fan; Chung, Fa Po; Ha, Trung Le; Singhal, Rahul; Chong, Eric; Yin, Wei-Hsian; Tsao, Hsuan‐Ming; Hsieh, Ming‐Hsiung; Chen, Shih‐Ann

doi:10.1111/jce.12036

Cited by 83 publications

(68 citation statements)

References 31 publications

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“…Inconsistent results in previous studies (Yamaguchi et al, 2010;Chang et al, 2013) might be secondary to differences at baseline, in AF type and provocation methods, and among others. As is the case for PV isolation procedure, supplementary ablation for some non-PV foci is an empirical therapy, and some non-PV firing may be an epiphenomenon of a real source located in the LA.…”

Section: Outcome Of Patients With Non-pv Foci Ablationmentioning

confidence: 66%

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

Cao

Dai

Jiang

et al. 2014

J. Zhejiang Univ. Sci. B

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Objective: To evaluate the incidence and clinical outcome of adenosine triphosphate (ATP) plus isoproterenol (ISP)-induced non-pulmonary vein (PV) foci before and after circumferential PV isolation (CPVI) during index ablation in patients with paroxysmal atrial fibrillation (PAF). Methods: In 80 consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April 2010 to January 2011, atrial fibrillation (AF) was provoked with ATP (20 mg) and ISP (20 µg/min) administration before and after CPVI. The spontaneous initiation of AF was mapped and recorded. Results: Before ablation, AF mostly originating from PVs (PV vs. non-PV, 36/70 vs. 3/70; P<0.01) was induced in 39 patients with sinus rhythm. CPVI significantly suppressed AF inducibility; however, more non-PV foci were provoked (post-CPVI vs. pre-CPVI, 13/76 vs. 3/70; P=0.016). Patients with pre-and post-CPVI induced AF (n=49) were divided according to non-PV foci being induced (group N, n=17) or not (group P, n=32). After mean (19.2±8.2) months follow-up, 88.2% (15/17) and 65.6% (21/32) of patients in groups N and P, respectively, were free from AF recurrence (P=0.088). Conclusions: ATP+ISP administration effectively provokes non-PV foci, especially after CPVI in PAF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.

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Section: Outcome Of Patients With Non-pv Foci Ablationmentioning

confidence: 66%

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

Cao

Dai

Jiang

et al. 2014

J. Zhejiang Univ. Sci. B

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“…[13][14][15][16][17] Followup periods have been as long as 6 years. Success rates have been consistently better in paroxysmal AF, particularly in those patients without structural heart disease and lowest in those with long-standing persistent AF, particularly in patients with comorbidities.…”

Section: Follow-up Results Of Catheter Ablation For Afmentioning

confidence: 99%

GP or No GP, Is That the Question?

Scherlag

2013

Circ: Arrhythmia and Electrophysiology

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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.…”

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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Long‐Term Outcome of Catheter Ablation in Patients with Atrial Fibrillation Originating from Nonpulmonary Vein Ectopy

Abstract: Compared to AF originating from the PV alone, AF originating from the NPV ectopy showed a worse outcome.

Cited by 83 publications

References 31 publications

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

GP or No GP, Is That the Question?

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

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Long‐Term Outcome of Catheter Ablation in Patients with Atrial Fibrillation Originating from Nonpulmonary Vein Ectopy

Abstract: Compared to AF originating from the PV alone, AF originating from the NPV ectopy showed a worse outcome.

Cited by 83 publications

References 31 publications

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

GP or No GP, Is That the Question?

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

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