TY - JOUR
T1 - Targeting non-pulmonary vein triggers in persistent atrial fibrillation
T2 - Results from a prospective, multicentre, observational registry
AU - Della Rocca, Domenico G.
AU - Di Biase, Luigi
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Gianni, Carola
AU - Romero, Jorge
AU - Tarantino, Nicola
AU - Magnocavallo, Michele
AU - Bassiouny, Mohamed
AU - Natale, Veronica N.
AU - Mayedo, Angel Quintero
AU - Macdonald, Bryan
AU - Lavalle, Carlo
AU - Murtaza, Ghulam
AU - Akella, Krishna
AU - Forleo, Giovanni B.
AU - Al-Ahmad, Amin
AU - Burkhardt, John David
AU - Gallinghouse, Gerald Joseph
AU - Sanchez, Javier E.
AU - Horton, Rodney P.
AU - Viles-Gonzalez, Juan F.
AU - Lakkireddy, Dhanunjaya
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2021 Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Aims: We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF). Methods and Results: A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW. A standardized protocol was performed to confirm persistent PVAI and elicit any triggers originating from non-PV sites. All non-PV triggers initiating sustained atrial tachyarrhythmias were ablated. Ablation of non-PV sites triggering non-sustained runs (<30 s) of atrial tachyarrhythmias or promoting frequent premature atrial complexes (≥10/min) was left to operator's discretion. Overall, 1319 (73.2%) patients had documented triggers from non-PV areas. After 17.4 ± 8.5 months of follow-up, the cumulative freedom from atrial tachyarrhythmias among patients without inducible non-PV triggers (n = 484) was 70.2%. Patients with ablation of induced non-PV triggers had a significantly higher arrhythmia control than those whose triggers were not ablated (67.9% vs. 39.4%, respectively; P < 0.001). After adjusting for clinically relevant variables, patients in whom non-PV triggers were documented but not ablated had an increased risk of arrhythmia relapse (hazard ratio: 2.39; 95% confidence interval: 2.01-2.83; P < 0.001). Conclusion: Pulmonary vein antrum isolation extended to the entire PW might provide acceptable long-term arrhythmia-free survival in PerAF patients without inducible non-PV triggers. In our population of PerAF patients, non-PV triggers could be elicited in ∼70% of PerAF patients and their elimination significantly improved outcomes.
AB - Aims: We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF). Methods and Results: A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW. A standardized protocol was performed to confirm persistent PVAI and elicit any triggers originating from non-PV sites. All non-PV triggers initiating sustained atrial tachyarrhythmias were ablated. Ablation of non-PV sites triggering non-sustained runs (<30 s) of atrial tachyarrhythmias or promoting frequent premature atrial complexes (≥10/min) was left to operator's discretion. Overall, 1319 (73.2%) patients had documented triggers from non-PV areas. After 17.4 ± 8.5 months of follow-up, the cumulative freedom from atrial tachyarrhythmias among patients without inducible non-PV triggers (n = 484) was 70.2%. Patients with ablation of induced non-PV triggers had a significantly higher arrhythmia control than those whose triggers were not ablated (67.9% vs. 39.4%, respectively; P < 0.001). After adjusting for clinically relevant variables, patients in whom non-PV triggers were documented but not ablated had an increased risk of arrhythmia relapse (hazard ratio: 2.39; 95% confidence interval: 2.01-2.83; P < 0.001). Conclusion: Pulmonary vein antrum isolation extended to the entire PW might provide acceptable long-term arrhythmia-free survival in PerAF patients without inducible non-PV triggers. In our population of PerAF patients, non-PV triggers could be elicited in ∼70% of PerAF patients and their elimination significantly improved outcomes.
KW - Catheter ablation
KW - Non-pulmonary vein triggers
KW - Outcomes
KW - Persistent atrial fibrillation
KW - Pulmonary veins
KW - Registry
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U2 - 10.1093/europace/euab161
DO - 10.1093/europace/euab161
M3 - Article
C2 - 34417816
AN - SCOPUS:85122206906
SN - 1099-5129
VL - 23
SP - 1939
EP - 1949
JO - Europace
JF - Europace
IS - 12
ER -