Beyond Pulmonary Vein Isolation in Nonparoxysmal Atrial Fibrillation: Posterior Wall, Vein of Marshall, Coronary Sinus, Superior Vena Cava, and Left Atrial Appendage

David F. Briceño, Kavisha Patel, Jorge Romero, Isabella Alviz, Nicola Tarantino, Domenico Della Rocca, Veronica Natale, Xiao Dong Zhang, Luigi Di Biase

Research output: Contribution to journalReview article

1 Scopus citations

Abstract

The optimal ablation strategy for non-paroxysmal atrial fibrillation remains controversial. Non-PV triggers have been shown to have a major arrhythmogenic role in these patients. Common sources of non-PV triggers are: posterior wall, left atrial appendage, superior vena cava, coronary sinus, vein of Marshall, interatrial septum, crista terminalis/Eustachian ridge, and mitral and tricuspid valve annuli. These sites are targeted empirically in selected cases or if significant ectopy is noted (with or without a drug challenge), to improve outcomes in patients with non-paroxysmal atrial fibrillation. This article focuses on summarizing the current evidence and the approach to mapping and ablation of these frequent non-PV trigger sites.

Original languageEnglish (US)
Pages (from-to)219-231
Number of pages13
JournalCardiac Electrophysiology Clinics
Volume12
Issue number2
DOIs
StatePublished - Jun 2020

Keywords

  • Ablation
  • Coronary sinus
  • LAA
  • Ligament of Marshall
  • Nonparoxysmal AF
  • Posterior wall
  • SVC

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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