Incidence and Location of Focal Atrial Fibrillation Triggers in Patients Undergoing Repeat Pulmonary Vein Isolation:
- 1 July 2003
- journal article
- clinical trial
- Published by Wiley in Journal of Cardiovascular Electrophysiology
- Vol. 14 (7) , 685-690
- https://doi.org/10.1046/j.1540-8167.2003.03013.x
Abstract
Introduction: The etiology of atrial fibrillation (AF) recurrences after pulmonary vein (PV) isolation is not well described. The aim of this study was to examine the reason for recurrent AF in patients undergoing a repeat attempt at AF trigger ablation. Methods and Results: Patients with recurrent AF more than 1 month after ablation returned for repeat mapping and ablation. A circular mapping catheter was advanced to each previously targeted PV ostium to determine if the PV was still electrically isolated. Ectopy then was provoked with isoproterenol (up to 20 μg/min), burst pacing, and pacing into AF followed by cardioversion. The location of ectopy triggering atrial premature depolarizations (APDs) or AF was noted. Of 226 patients who underwent ablation of AF triggers, 34 (8 women and 26 men; age 56 ± 10 years) with recurrent AF returned for a repeat procedure 207 ± 183 days after the first procedure. There were 84 previously completely isolated PVs in these 34 patients. Thirty‐three (39%) of 84 previously isolated PVs were still completely isolated at the time of the second procedure. Fifty‐one PVs (61%) had evidence of recovered PV potentials. Fifty triggers of APDs and AF (n = 30) or APDs only (n = 20) were identified in these 34 patients. The majority of triggers [27/50 (54%)] originated from previously targeted PVs. Sixteen triggers [16/50 (32%)] originated from previously nontargeted PVs. Conclusion: The majority of AF recurrences originate from previously isolated PVs. One third of recurrent triggers originated from PVs that were not targeted during the initial ablation session. Although empiric isolation of all PVs may reduce recurrences, strategies to ensure ostial PV isolation and to prevent recurrent PV conduction after ablation should have the greatest impact on reducing AF recurrence. (J Cardiovasc Electrophysiol, Vol. 14, pp. 685‐690, July 2003)Keywords
This publication has 14 references indexed in Scilit:
- Electrophysiologic and Anatomic Characterization of Sites Resistant to Electrical Isolation During Circumferential Pulmonary Vein Ablation for Atrial Fibrillation: A Prospective StudyJournal of Cardiovascular Electrophysiology, 2007
- Intracardiac Doppler Echocardiographic Quantification of Pulmonary Vein Flow Velocity: An Effective Technique for Monitoring Pulmonary Vein Ostia Narrowing During Focal Atrial Fibrillation AblationJournal of Cardiovascular Electrophysiology, 2002
- Utility of Exit Block for Identifying Electrical Isolation of the Pulmonary VeinsJournal of Cardiovascular Electrophysiology, 2002
- Pulmonary Vein Isolation for Paroxysmal and Persistent Atrial FibrillationCirculation, 2002
- Clinical Outcome after Radiofrequency Catheter Ablation of Focal Atrial Fibrillation TriggersJournal of Cardiovascular Electrophysiology, 2001
- Circumferential Radiofrequency Ablation of Pulmonary Vein OstiaCirculation, 2000
- Electrophysiological Breakthroughs From the Left Atrium to the Pulmonary VeinsCirculation, 2000
- First Human Experience With Pulmonary Vein Isolation Using a Through-the-Balloon Circumferential Ultrasound Ablation System for Recurrent Atrial FibrillationCirculation, 2000
- Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Pulmonary VeinsCirculation, 1999
- Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary VeinsNew England Journal of Medicine, 1998