Extra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation

Background: Extra-pulmonary vein triggers can play a significant role in atrial fibrillation recurrence after catheter ablation. We explored the characteristics of the extra-pulmonary vein (PV) triggers in de novo and repeat atrial fibrillation (AF) catheter ablation (AFCA).Methods: We included 2,11...

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Autores principales:	Daehoon Kim, Taehyun Hwang, Min Kim, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Hui-Nam Pak
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	atrial fibrillation catheter ablation recurrence extra-pulmonary vein triggers remodeling Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/45774f7d6e604628ae30414946192377
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spelling	oai:doaj.org-article:45774f7d6e604628ae304149461923772021-11-04T07:14:37ZExtra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation2297-055X10.3389/fcvm.2021.759967https://doaj.org/article/45774f7d6e604628ae304149461923772021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.759967/fullhttps://doaj.org/toc/2297-055XBackground: Extra-pulmonary vein triggers can play a significant role in atrial fibrillation recurrence after catheter ablation. We explored the characteristics of the extra-pulmonary vein (PV) triggers in de novo and repeat atrial fibrillation (AF) catheter ablation (AFCA).Methods: We included 2,118 patients who underwent a de novo AFCA (women 27.6%, 59.2 ± 10.9 years old, paroxysmal AF 65.9%) and 227 of them conducted repeat procedures. All included patients underwent isoproterenol provocation tests at the end of the procedure, and then we analyzed extra-PV triggers-related factors.Results: Extra-PV triggers were documented in 11.7% of patients undergoing de novo AFCA (1.22 ± 0.46 foci per patient) and 28.6% undergoing repeat AFCA (1.49 ± 0.73 foci per patient). Older age and higher LA volume index in de novo procedures and women, diabetes, and higher parasympathetic nerve activity (heart rate variability) in repeat-AFCA were independently associated with the existence of extra-PV triggers. The septum (19.9%), coronary sinus (14.7%), and superior vena cava (11.2%) were common extra-PV foci. Among 46 patients who were newly found to have mappable extra-PV triggers upon repeat procedures, 15 (32.6%) matched with the previous focal or empirical extra-PV ablation sites. The rate of AF recurrence was significantly higher in patients with extra-PV triggers than in those without after de novo (HR 1.91, 95% CI 1.54–2.38, p < 0.001) and repeat procedures (HR 2.68, 95% CI 1.63–4.42, p < 0.001).Conclusions: Extra-PV triggers were commonly found in AF patients with significant remodeling and previous empirical extra-PV ablation. The existence of extra-PV triggers was independently associated with poorer rhythm outcomes after the de novo and repeat AFCA.Daehoon KimTaehyun HwangMin KimHee Tae YuTae-Hoon KimJae-Sun UhmBoyoung JoungMoon-Hyoung LeeHui-Nam PakFrontiers Media S.A.articleatrial fibrillationcatheter ablationrecurrenceextra-pulmonary vein triggersremodelingDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation catheter ablation recurrence extra-pulmonary vein triggers remodeling Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial fibrillation catheter ablation recurrence extra-pulmonary vein triggers remodeling Diseases of the circulatory (Cardiovascular) system RC666-701 Daehoon Kim Taehyun Hwang Min Kim Hee Tae Yu Tae-Hoon Kim Jae-Sun Uhm Boyoung Joung Moon-Hyoung Lee Hui-Nam Pak Extra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation
description	Background: Extra-pulmonary vein triggers can play a significant role in atrial fibrillation recurrence after catheter ablation. We explored the characteristics of the extra-pulmonary vein (PV) triggers in de novo and repeat atrial fibrillation (AF) catheter ablation (AFCA).Methods: We included 2,118 patients who underwent a de novo AFCA (women 27.6%, 59.2 ± 10.9 years old, paroxysmal AF 65.9%) and 227 of them conducted repeat procedures. All included patients underwent isoproterenol provocation tests at the end of the procedure, and then we analyzed extra-PV triggers-related factors.Results: Extra-PV triggers were documented in 11.7% of patients undergoing de novo AFCA (1.22 ± 0.46 foci per patient) and 28.6% undergoing repeat AFCA (1.49 ± 0.73 foci per patient). Older age and higher LA volume index in de novo procedures and women, diabetes, and higher parasympathetic nerve activity (heart rate variability) in repeat-AFCA were independently associated with the existence of extra-PV triggers. The septum (19.9%), coronary sinus (14.7%), and superior vena cava (11.2%) were common extra-PV foci. Among 46 patients who were newly found to have mappable extra-PV triggers upon repeat procedures, 15 (32.6%) matched with the previous focal or empirical extra-PV ablation sites. The rate of AF recurrence was significantly higher in patients with extra-PV triggers than in those without after de novo (HR 1.91, 95% CI 1.54–2.38, p < 0.001) and repeat procedures (HR 2.68, 95% CI 1.63–4.42, p < 0.001).Conclusions: Extra-PV triggers were commonly found in AF patients with significant remodeling and previous empirical extra-PV ablation. The existence of extra-PV triggers was independently associated with poorer rhythm outcomes after the de novo and repeat AFCA.
format	article
author	Daehoon Kim Taehyun Hwang Min Kim Hee Tae Yu Tae-Hoon Kim Jae-Sun Uhm Boyoung Joung Moon-Hyoung Lee Hui-Nam Pak
author_facet	Daehoon Kim Taehyun Hwang Min Kim Hee Tae Yu Tae-Hoon Kim Jae-Sun Uhm Boyoung Joung Moon-Hyoung Lee Hui-Nam Pak
author_sort	Daehoon Kim
title	Extra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation
title_short	Extra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation
title_full	Extra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation
title_fullStr	Extra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation
title_full_unstemmed	Extra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation
title_sort	extra-pulmonary vein triggers at de novo and the repeat atrial fibrillation catheter ablation
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/45774f7d6e604628ae30414946192377
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Extra-Pulmonary Vein Triggers at de novo and the Repeat Atrial Fibrillation Catheter Ablation

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