Distribution Patterns of Paroxysmal Atrial Fibrillation Triggers and Catheter Ablation Success Rates

• Published in: Annals of noninvasive electrocardiology Vol. 30; no. 2; pp. e70065 - n/a
• Main Authors: Zhao, Dongsheng, Dong, Yan, Chen, Qiushi, Zhang, Fengxiang, Zheng, Koulong
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2025; John Wiley and Sons Inc; Wiley
• Subjects: Ablation; Adenosine triphosphate; Aged; Arrhythmia; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; atrial fibrillation induction; Cardiac arrhythmia; Catheter Ablation - methods; Catheters; Diabetes; Effectiveness; Electrocardiography, Ambulatory - methods; Electrodes; Female; Fibrillation; Humans; Hypertension; Male; Medical instruments; Middle Aged; non‐PV trigger; Normal distribution; Original; paroxysmal atrial fibrillation; Patients; prognosis; Prospective Studies; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Radiofrequency ablation; Recurrence; Statistical analysis; Stimulation; Surgery; Surgical outcomes; Treatment Outcome; trigger ablation; Ultrasonic imaging; Veins; paroxysmal atrial fibrillation; trigger ablation; atrial fibrillation induction; prognosis; non‐PV trigger
• ISSN: 1082-720X; 1542-474X; 1542-474X
• DOI: 10.1111/anec.70065

ABSTRACT Objective Investigate the distribution of triggers in paroxysmal atrial fibrillation (PAF) patients and assess the efficacy of circumferential pulmonary vein isolationI (CPVI) combined with non‐pulmonary veins (PV) trigger ablation over 1 year. Methods This prospective study included 130 PAF patients undergoing initial catheter ablation. A standardized protocol was applied before CPVI, followed by ablation targeting non‐PV triggers. Ablation success was marked by the inability to induce atrial fibrillation (AF) or related arrhythmias. Patients underwent Holter monitoring at intervals post‐surgery, culminating in a 7‐day exam at 12 months. Results Atrial fibrillation (AF) was induced in 88 patients (67.0%), with 94 foci identified. The left pulmonary vein was a common source, but the superior vena cava emerged as the most prevalent non‐PV site. The 1‐year success rate was 86.0%, with no significant differences in success rates among trigger types. However, non‐PV triggers were linked to lower recurrence rates post‐surgery (HR 0.27, 95% CI 0.08–0.96, p = 0.04). Conclusion The study found that the combination of drug stimulation and high‐frequency atrial stimulation before CPVI significantly boosted AF induction rates and revealed a high incidence of non‐PV triggers. Effective intraoperative induction and accurate identification of non‐PV triggers, particularly in the superior vein cava (SVC), contributed to a substantial reduction in postoperative recurrence rates. This approach suggests a potential strategy for improving outcomes in PAF treatment. The utilization of drug stimulation and high‐frequency atrial stimulation preceding circumferential pulmonary vein isolationI (CPVI) significantly increased the induction rate of atrial fibrillation (AF), alongside a notable incidence of non‐pulmonary veins (PV) triggers, with the superior vein cava (SVC) emerging as the most prevalent site. Effective intraoperative induction and precise identification of non‐PV triggers have demonstrated a reduction in postoperative recurrence rates.