Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation.
<h4>Background</h4>Pulmonary vein isolation (PVI) is an established ablation procedure for atrial fibrillation (AF), however, PVI alone is insufficient to suppress AF recurrence. Non-pulmonary vein (non-PV) trigger ablation is one of the promising strategies beyond PVI and has been shown...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0264894 |
| _version_ | 1828269584258433024 |
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| author | Kazuo Sakamoto Yasushi Mukai Shunsuke Kawai Kazuhiro Nagaoka Shujiro Inoue Susumu Takase Daisuke Yakabe Shota Ikeda Hiroshi Mannoji Tomomi Nagayama Akiko Chishaki Hiroyuki Tsutsui |
| author_facet | Kazuo Sakamoto Yasushi Mukai Shunsuke Kawai Kazuhiro Nagaoka Shujiro Inoue Susumu Takase Daisuke Yakabe Shota Ikeda Hiroshi Mannoji Tomomi Nagayama Akiko Chishaki Hiroyuki Tsutsui |
| author_sort | Kazuo Sakamoto |
| collection | DOAJ |
| description | <h4>Background</h4>Pulmonary vein isolation (PVI) is an established ablation procedure for atrial fibrillation (AF), however, PVI alone is insufficient to suppress AF recurrence. Non-pulmonary vein (non-PV) trigger ablation is one of the promising strategies beyond PVI and has been shown to be effective in refractory/persistent AF cases. To make non-PV trigger ablation more standardized, it is essential to develop a simple method to localize the origin of non-PV triggers.<h4>Methods</h4>We retrospectively analyzed 37 non-PV triggers in 751 ablation sessions for symptomatic AF from January 2017 to December 2020. Regarding non-PV triggers, intra-atrial activation interval from the earliest in right atrium (RA) to proximal coronary sinus (CS) (RA-CSp) and that from the earliest in RA to distal CS (RA-CSd) obtained by a basically-positioned duodecapolar RA-CS catheter were compared among 3 originating non-PV areas [RA, atrial septum (SEP) and left atrium (LA)].<h4>Results</h4>RA-CSp of RA non-PV trigger (56.4 ± 23.4 ms) was significantly longer than that of SEP non-PV (14.8 ± 25.6 ms, p = 0.019) and LA non-PV (-24.9 ± 27.9 ms, p = 0.0004). RA-CSd of RA non-PV (75.9 ± 32.1 ms) was significantly longer than that of SEP non-PV (34.2 ± 32.6 ms, p = 0.040) and LA non-PV (-13.3 ± 41.2 ms, p = 0.0008). RA-CSp and RA-CSd of SEP non-PV were significantly longer than those of LA non-PV (p = 0.022 and p = 0.016, respectively). Sensitivity and specificity of an algorithm to differentiate the area of non-PV trigger using RA-CSp (cut-off value: 50 ms) and RA-CSd (cut-off value: 0 ms) were 88% and 97% for RA non-PV, 81% and 73% for SEP non-PV, 65% and 95% for LA non-PV, respectively.<h4>Conclusions</h4>The analysis of intra-atrial activation sequences was useful to differentiate non-PV trigger areas. A simple algorithm to localize the area of non-PV trigger would be helpful to identify non-PV trigger sites in AF ablation. |
| first_indexed | 2024-04-13T05:32:48Z |
| format | Article |
| id | doaj.art-1c14f512b4be4ba2afc69145a5084777 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T05:32:48Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-1c14f512b4be4ba2afc69145a50847772022-12-22T03:00:23ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01174e026489410.1371/journal.pone.0264894Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation.Kazuo SakamotoYasushi MukaiShunsuke KawaiKazuhiro NagaokaShujiro InoueSusumu TakaseDaisuke YakabeShota IkedaHiroshi MannojiTomomi NagayamaAkiko ChishakiHiroyuki Tsutsui<h4>Background</h4>Pulmonary vein isolation (PVI) is an established ablation procedure for atrial fibrillation (AF), however, PVI alone is insufficient to suppress AF recurrence. Non-pulmonary vein (non-PV) trigger ablation is one of the promising strategies beyond PVI and has been shown to be effective in refractory/persistent AF cases. To make non-PV trigger ablation more standardized, it is essential to develop a simple method to localize the origin of non-PV triggers.<h4>Methods</h4>We retrospectively analyzed 37 non-PV triggers in 751 ablation sessions for symptomatic AF from January 2017 to December 2020. Regarding non-PV triggers, intra-atrial activation interval from the earliest in right atrium (RA) to proximal coronary sinus (CS) (RA-CSp) and that from the earliest in RA to distal CS (RA-CSd) obtained by a basically-positioned duodecapolar RA-CS catheter were compared among 3 originating non-PV areas [RA, atrial septum (SEP) and left atrium (LA)].<h4>Results</h4>RA-CSp of RA non-PV trigger (56.4 ± 23.4 ms) was significantly longer than that of SEP non-PV (14.8 ± 25.6 ms, p = 0.019) and LA non-PV (-24.9 ± 27.9 ms, p = 0.0004). RA-CSd of RA non-PV (75.9 ± 32.1 ms) was significantly longer than that of SEP non-PV (34.2 ± 32.6 ms, p = 0.040) and LA non-PV (-13.3 ± 41.2 ms, p = 0.0008). RA-CSp and RA-CSd of SEP non-PV were significantly longer than those of LA non-PV (p = 0.022 and p = 0.016, respectively). Sensitivity and specificity of an algorithm to differentiate the area of non-PV trigger using RA-CSp (cut-off value: 50 ms) and RA-CSd (cut-off value: 0 ms) were 88% and 97% for RA non-PV, 81% and 73% for SEP non-PV, 65% and 95% for LA non-PV, respectively.<h4>Conclusions</h4>The analysis of intra-atrial activation sequences was useful to differentiate non-PV trigger areas. A simple algorithm to localize the area of non-PV trigger would be helpful to identify non-PV trigger sites in AF ablation.https://doi.org/10.1371/journal.pone.0264894 |
| spellingShingle | Kazuo Sakamoto Yasushi Mukai Shunsuke Kawai Kazuhiro Nagaoka Shujiro Inoue Susumu Takase Daisuke Yakabe Shota Ikeda Hiroshi Mannoji Tomomi Nagayama Akiko Chishaki Hiroyuki Tsutsui Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation. PLoS ONE |
| title | Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation. |
| title_full | Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation. |
| title_fullStr | Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation. |
| title_full_unstemmed | Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation. |
| title_short | Intra-atrial activation pattern is useful to localize the areas of non-pulmonary vein triggers of atrial fibrillation. |
| title_sort | intra atrial activation pattern is useful to localize the areas of non pulmonary vein triggers of atrial fibrillation |
| url | https://doi.org/10.1371/journal.pone.0264894 |
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