Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome

Background: The clinical characteristics of atrial fibrillation (AF) resulting from non-pulmonary vein (PV) triggers remain unknown. This study aimed to evaluate the clinical characteristics of patients with AF caused by non-PV triggers, localization of non-PV foci, clinical differences, and clinica...

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Main Authors: Yukihiro Inamura, Junichi Nitta, Osamu Inaba, Akira Sato, Tomomasa Takamiya, Kazuya Murata, Takashi Ikenouchi, Toshikazu Kono, Yutaka Matsumura, Yoshihide Takahashi, Masahiko Goya, Tetsuo Sasano
Format: Article
Language:English
Published: Elsevier 2021-02-01
Series:International Journal of Cardiology: Heart & Vasculature
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Online Access:http://www.sciencedirect.com/science/article/pii/S2352906721000051
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author Yukihiro Inamura
Junichi Nitta
Osamu Inaba
Akira Sato
Tomomasa Takamiya
Kazuya Murata
Takashi Ikenouchi
Toshikazu Kono
Yutaka Matsumura
Yoshihide Takahashi
Masahiko Goya
Tetsuo Sasano
author_facet Yukihiro Inamura
Junichi Nitta
Osamu Inaba
Akira Sato
Tomomasa Takamiya
Kazuya Murata
Takashi Ikenouchi
Toshikazu Kono
Yutaka Matsumura
Yoshihide Takahashi
Masahiko Goya
Tetsuo Sasano
author_sort Yukihiro Inamura
collection DOAJ
description Background: The clinical characteristics of atrial fibrillation (AF) resulting from non-pulmonary vein (PV) triggers remain unknown. This study aimed to evaluate the clinical characteristics of patients with AF caused by non-PV triggers, localization of non-PV foci, clinical differences, and clinical outcomes after catheter ablation in each AF focus. Methods: A total of 2967 patients who underwent initial catheter ablation for paroxysmal or persistent AF were examined. After PV isolation, all patients underwent high-dose isoproterenol infusion to assess the existence of non-PV foci. Results: Non-PV foci were identified in 564 patients (19.2%). The localization of successfully ablated non-PV foci in 514 patients were the superior vena cava (SVC: 213 cases), interatrial septum (IAS: 125 cases), coronary sinus (CS: 98 cases), right atrium (RA: 125 cases), left atrium (LA: 114 cases), and unmappable (50 cases). Multivariate analysis revealed that female gender, low body mass index (BMI), non-paroxysmal AF (PAF), and sick sinus syndrome were independent and significant indicators of non-PV foci. In the multivariate analysis of each AF focus, female gender, low BMI, and non-PAF were significant predictors of IAS and CS foci, RA and IAS foci, and CS foci, respectively. In addition, dilatation of the LA was significantly associated with LA foci, whereas RA, LA, IAS, and CS foci were associated with AF recurrence. Conclusion: These findings could help to identify patients at a higher risk of AF caused by non-PV triggers and clarify the clinical difference according to the localization of non-PV foci.
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spelling doaj.art-221a2760765c4b1cb9b75a8be2a9a45a2022-12-21T23:06:00ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672021-02-0132100717Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcomeYukihiro Inamura0Junichi Nitta1Osamu Inaba2Akira Sato3Tomomasa Takamiya4Kazuya Murata5Takashi Ikenouchi6Toshikazu Kono7Yutaka Matsumura8Yoshihide Takahashi9Masahiko Goya10Tetsuo Sasano11Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan; Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan; Corresponding author at: Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama 330-8553, Japan.Department of Cardiology, Sakakibara Heart Institute, Tokyo, JapanDepartment of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, JapanDepartment of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, JapanDepartment of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, JapanDepartment of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, JapanDepartment of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, JapanDepartment of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, JapanDepartment of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, JapanDepartment of Cardiology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Cardiology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Cardiology, Tokyo Medical and Dental University, Tokyo, JapanBackground: The clinical characteristics of atrial fibrillation (AF) resulting from non-pulmonary vein (PV) triggers remain unknown. This study aimed to evaluate the clinical characteristics of patients with AF caused by non-PV triggers, localization of non-PV foci, clinical differences, and clinical outcomes after catheter ablation in each AF focus. Methods: A total of 2967 patients who underwent initial catheter ablation for paroxysmal or persistent AF were examined. After PV isolation, all patients underwent high-dose isoproterenol infusion to assess the existence of non-PV foci. Results: Non-PV foci were identified in 564 patients (19.2%). The localization of successfully ablated non-PV foci in 514 patients were the superior vena cava (SVC: 213 cases), interatrial septum (IAS: 125 cases), coronary sinus (CS: 98 cases), right atrium (RA: 125 cases), left atrium (LA: 114 cases), and unmappable (50 cases). Multivariate analysis revealed that female gender, low body mass index (BMI), non-paroxysmal AF (PAF), and sick sinus syndrome were independent and significant indicators of non-PV foci. In the multivariate analysis of each AF focus, female gender, low BMI, and non-PAF were significant predictors of IAS and CS foci, RA and IAS foci, and CS foci, respectively. In addition, dilatation of the LA was significantly associated with LA foci, whereas RA, LA, IAS, and CS foci were associated with AF recurrence. Conclusion: These findings could help to identify patients at a higher risk of AF caused by non-PV triggers and clarify the clinical difference according to the localization of non-PV foci.http://www.sciencedirect.com/science/article/pii/S2352906721000051Catheter ablationAtrial fibrillationPulmonary vein isolationNon-pulmonary vein foci
spellingShingle Yukihiro Inamura
Junichi Nitta
Osamu Inaba
Akira Sato
Tomomasa Takamiya
Kazuya Murata
Takashi Ikenouchi
Toshikazu Kono
Yutaka Matsumura
Yoshihide Takahashi
Masahiko Goya
Tetsuo Sasano
Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome
International Journal of Cardiology: Heart & Vasculature
Catheter ablation
Atrial fibrillation
Pulmonary vein isolation
Non-pulmonary vein foci
title Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome
title_full Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome
title_fullStr Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome
title_full_unstemmed Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome
title_short Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome
title_sort presence of non pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation clinical characteristics and long term ablation outcome
topic Catheter ablation
Atrial fibrillation
Pulmonary vein isolation
Non-pulmonary vein foci
url http://www.sciencedirect.com/science/article/pii/S2352906721000051
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