title: Characterization of non-pulmonary vein foci with an EnSite array in patients with paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  Non-pulmonary vein (PV) foci are sometimes difficult to identify and eliminate. The EnSite array (EA) reveals the detailed beat-to-beat virtual activation. This study aimed to characterize non-PV foci using the EA.
  
  
  RESULTS
  Sixty-five patients with paroxysmal atrial fibrillation (AF) were included. All had ectopy initiating AF and/or focal atrial tachycardia analysed using the EA. All patients underwent PV isolation (PVI) and additional ablation of non-PV foci if present. The EA revealed 59 PV foci in 48 patients (Group P) and 19 non-PV foci in 17 patients (Group N). In Group N, 12 patients (71%) also had 17 PV foci. The non-PV foci were frequently distributed in the left atrial (LA) roof (n = 5) and superior vena cava (n = 5). Pulmonary vein isolation during on-going AF terminated AF in 34 of 37 in Group P (92%) and 4 of 14 in Group N (29%) patients (P < 0.0001). All non-PV foci were eliminated by an EA-guided ablation. During a 23 ± 10 month follow-up, 11 patients (17%) had AF recurrences, mainly due to LA-PV reconnection.
  
  
  CONCLUSIONS
  Non-PV foci are prevalent in the LA roof and SVC sites, but can originate from other sites as well. When non-PV foci are observed, PVI may be insufficient and should be supplemented with non-PV foci ablation.
authors.affiliation: EP Expert Doctors-Team Tsuchiya, Koto 3-14-28, Kumamoto 862-0909, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Koji
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Nagamoto
authors.forename: Naohiko
authors.initials: N
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006329:Heart Conduction System / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology* / Q000503:physiopathology; D012189:Retrospective Studies