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Ikenouchi T, Nitta J, Inaba O, Kono T, Murata K, Takamiya T, Inamura Y, Sato A, Matsumura Y, Takahashi Y, Goya M, Sasano T. Effect of isolation feasibility of non-pulmonary vein foci on efficacy of ablation for atrial fibrillation: comparison of the isolation and focal ablation methods. J Interv Card Electrophysiol 2022; 65:441-451. [PMID: 35445888 DOI: 10.1007/s10840-022-01217-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Atrial fibrillation (AF) mainly originates from the pulmonary vein (PV). However, some AF triggers originate from other sites, namely non-PV foci, which are related to recurrence after AF ablation. This study aimed to evaluate the effects of isolation feasibility (isolability) of non-PV foci on the efficacy of AF ablation. METHODS Overall, 1855 patients with AF (age, 64.6 ± 10.9 years; 82% paroxysmal) underwent PV isolation, followed by induction and ablation of non-PV foci. Among them, 545 (29%) patients had non-PV foci; these patients were categorized into those with isolable non-PV foci (n = 196, 36%) and those with non-isolable non-PV foci (n = 349, 64%). RESULTS During a mean follow-up of 31.2 ± 15.6 months, recurrence was higher in the non-isolable group than in the isolable group (34% vs. 19%, P < 0.01). Kaplan-Meier analyses revealed a significantly better 1-year clinical outcome in the isolable group than in the non-isolable group (88.0% vs. 78.4%, P < 0.001; hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.39-0.81). This outcome was not inferior to that of patients without non-PV foci (88.3% vs. 90.8%, P = 0.81). The non-isolable group showed poorer clinical outcomes than patients without non-PV foci (78.4% vs. 90.8%, P < 0.001; HR, 1.37; 95% CI, 1.22-1.53). Cox regression analysis revealed that isolability (HR, 0.56; 95% CI, 0.36-0.89) and unmappability (HR, 2.89; 95% CI, 1.55-5.37) of non-PV foci were significant predictors of arrhythmia recurrence. CONCLUSION The isolability of non-PV foci was a significant factor affecting the achievement of better clinical outcomes following AF ablation in patients with non-PV foci.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo To, 113-8510, Japan.
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu-shi, Tokyo To, 183-0003, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-kuSaitama Prefecture, Saitama City, 330-8553, Japan
| | - Toshikazu Kono
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-kuSaitama Prefecture, Saitama City, 330-8553, Japan
| | - Kazuya Murata
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-kuSaitama Prefecture, Saitama City, 330-8553, Japan
| | - Tomomasa Takamiya
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-kuSaitama Prefecture, Saitama City, 330-8553, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-kuSaitama Prefecture, Saitama City, 330-8553, Japan
| | - Akira Sato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-kuSaitama Prefecture, Saitama City, 330-8553, Japan
| | - Yutaka Matsumura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-kuSaitama Prefecture, Saitama City, 330-8553, Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo To, 113-8510, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo To, 113-8510, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo To, 113-8510, Japan
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