title: [Clinical characteristics and long-term outcome of non-pulmonary vein foci ablation in patients with paroxysmal atrial fibrillation].
abstract: OBJECTIVE
  To evaluate the clinical characteristics and long-term results of non-pulmonary veins (PV) trigger ablation in patients with paroxysmal atrial fibrillation (AF).
  
  
  METHODS
  Eighty-six patients [48 men, mean age (52.3 ± 10.2) years] were included in the study. Circumferential pulmonary vein antrum isolation guided by a 3-D mapping system was performed. Aggressive high right atrium programmed stimulation and burst pacing were made before and after isoproterenol infusion. Additional ablation was performed if other trigger foci were found or other sustained tachycardias could be induced.
  
  
  RESULTS
  PV triggers were observed in 59 patients (group I), and non-PV triggers were observed in 27 patients (group II), 12 non-PV triggers were identified during the first procedure. Among them, one was located in the roof of left atrium, 11 were originated from superior vena cava. After a mean follow-up of [37.1 ± 10.4 (range 15-60)] months, the AF recurrence rate was significantly higher in the Group II than in the Group I (55.5% vs. 20.3%, P = 0.001). The number of performed ablation was also significantly in group II than in group I higher difference (1.7 ± 0.8 vs. 1.1 ± 0.4, P < 0.001). In the group II, 15/15 (100%) patients had a repeated ablation procedure for AF recurrence, and 15 patients had new non-PV foci after isoproterenol infusion which were originated from the superior vena cava (n = 11) and coronary sinus (n = 2), respectively. After the second ablation procedure, AF recurrence was observed in three patients, two patients accepted third procedure, the non-PV triggers were located in left atrial septum and coronary sinus, and one patient accepted fourth procedure, the non-PV foci was located in left posterior wall.
  
  
  CONCLUSIONS
  Non-PV foci may occur at any age and the main area is located in the super vena cava, Non-PV serves as a major cause of AF recurrence after successful PVAI.
authors.affiliation: The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Hong-wu
authors.initials: HW
authors.lastname: Chen
authors.affiliation: The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China. Email: chenminglong2001@163.com.
authors.forename: Ming-long
authors.initials: ML
authors.lastname: Chen
authors.affiliation: The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.affiliation: The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Wei-zhu
authors.initials: WZ
authors.lastname: Ju
authors.affiliation: The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Feng-xiang
authors.initials: FX
authors.lastname: Zhang
authors.affiliation: The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Gu
authors.affiliation: The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Ming-fang
authors.initials: MF
authors.lastname: Li
authors.affiliation: The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Ke-jiang
authors.initials: KJ
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*; D012008:Recurrence; D016896:Treatment Outcome