Multiple Arrhythmogenic Foci Associated With the Development of Perpetuation of Atrial Fibrillation

Kurotobi, Toshiya; Iwakura, Katsuomi; Inoue, Koichi; Kimura, Ryusuke; Okamura, Atsunori; Koyama, Yasushi; Tosyoshima, Yuko; Ito, Norihisa; Fujii, Kenshi

doi:10.1161/circep.109.885095

Cited by 43 publications

(26 citation statements)

References 44 publications

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“…[27][28][29][30] Non-PV triggers by themselves are known strong predictors of ATa recurrences: many studies have shown that their presence in the index procedure is associated with long-term AF recurrence, even in patients with PAF. [31][32][33] 15…”

Section: Predictors Of Atrial Tachyarrhythmias Recurrencementioning

confidence: 99%

Importance of non–pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction

et al. 2016

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Section: Predictors Of Atrial Tachyarrhythmias Recurrencementioning

confidence: 99%

Importance of non–pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction

et al. 2016

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“…We previously reported that multiple triggers were likely to be involved in the development of AF persistence. 9 In addition to the multiplicity of the AF triggers, the activity of the AF triggers might also have a great impact on the persistence.…”

Section: Ablation Of the Af Substrate In The Peaf Patientsmentioning

confidence: 99%

Trigger-Based Mechanism of the Persistence of Atrial Fibrillation and Its Impact on the Efficacy of Catheter Ablation

Inoue

Kurotobi²,

Kimura³

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-We investigated the possibility that a frequent trigger action might play a role in the development of persistent atrial fibrillation (PeAF) and the presence of a substrate. Methods and Results-In 263 consecutive patients who underwent catheter ablation (CA) for PeAF, electric cardioversion was performed at the beginning of the procedure to determine the presence or absence of an immediate recurrence of AF (IRAF).We defined an IRAF as a reproducible AF recurrence within 90 s after restoration of sinus rhythm by electric cardioversion.We performed a meanϮSD of 1.3Ϯ0.5 sessions of CA, including pulmonary vein isolation and ablation of the premature atrial contractions that triggered the IRAF (IRAF triggers), and observed the patients for 17 (10 -27) months. An IRAF was observed in 70 patients (27%), but we could not ablate the IRAF triggers in 16 (23%) of these IRAF patients. The recurrence rate of PeAF was higher in patients with an unsuccessful IRAF trigger ablation than in those with successful IRAF trigger ablation (63% versus 11%; PϽ0.001). A multivariable analysis also revealed that an unsuccessful IRAF trigger ablation was 1 of the independent predictors of recurrent PeAF (odds ratio, 10.9; 95% CI, 3.4 -36.7). Conclusions-In the PeAF patients with an IRAF, successful elimination of the IRAF triggers, in addition to pulmonary vein isolation, resulted in a successful CA. These results imply that such triggers play a major role in the AF persistence in these PeAF patients. (Circ Arrhythm Electrophysiol. 2012;5:295-301.)

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“…59,75 Current guidelines recommend consideration of more extensive ablation in this cohort in order to address a higher number of non-PV triggers. 76 However RCT data for this approach have been inconsistent (Table 3). …”

Section: Af Treatment Trials: Filling In the Gapsmentioning

confidence: 99%

The burden of proof: The current state of atrial fibrillation prevention and treatment trials

et al. 2017

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Atrial fibrillation (AF) is an age-related arrhythmia of enormous socioeconomic significance. In recent years, our understanding of the basic mechanisms that initiate and perpetuate AF has evolved rapidly, catheter ablation of AF has progressed from concept to reality, and recent studies suggest lifestyle modification may help prevent AF recurrence. Emerging developments in genetics, imaging, and informatics also present new opportunities for personalized care. However, considerable challenges remain. These include a paucity of studies examining AF prevention, modest efficacy of existing antiarrhythmic therapies, diverse ablation technologies and practice, and limited evidence to guide management of high-risk patients with multiple comorbidities. Studies examining the long-term effects of AF catheter ablation on morbidity and mortality outcomes are not yet completed. In many ways, further progress in the field is heavily contingent on the feasibility, capacity, and efficiency of clinical trials to incorporate the rapidly evolving knowledge base and to provide substantive evidence for novel AF therapeutic strategies. This review outlines the current state of AF prevention and treatment trials, including the foreseeable challenges, as discussed by a unique forum of clinical trialists, scientists, and regulatory representatives in a session endorsed by the Heart Rhythm Society at the 12th Global CardioVascular Clinical Trialists Forum in Washington, DC, December 3–5, 2015.

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Multiple Arrhythmogenic Foci Associated With the Development of Perpetuation of Atrial Fibrillation

Cited by 43 publications

References 44 publications

Importance of non–pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction

Importance of non–pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction

Trigger-Based Mechanism of the Persistence of Atrial Fibrillation and Its Impact on the Efficacy of Catheter Ablation

The burden of proof: The current state of atrial fibrillation prevention and treatment trials

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