title: Impact of Non-Pulmonary Vein Foci on the Outcome of the Second Session of Catheter Ablation for Paroxysmal Atrial Fibrillation.
abstract: BACKGROUND
  Paroxysmal atrial fibrillation (AF) is primarily triggered by pulmonary veins (PVs). However, non-PV AF foci may also trigger AF.
  
  
  METHODS
  We examined 207 patients (mean age, 62 ± 11 years; 166 men) who underwent a second catheter ablation (CA) and evaluated the clinical significance of non-PV AF foci on the outcomes.
  
  
  RESULTS
  Electrical reconnections between the PVs and left atrium (LA) were observed in 162 patients (78.3%). Non-PV AF foci were identified in 95 patients (45.9%, 60 patients with successfully ablated non-PV AF foci and 35 with unmappable non-PV AF foci). During a median follow-up period of 22.7 months, 61 patients (29.5%; 18/112 [16.1%] without non-PV AF foci vs. 20/60 [33.3%] with successfully ablated non-PV AF foci vs. 23/35 [65.7%] with unmappable non-PV AF foci, P < 0.0001) developed AF recurrence; 52 (85.2%) developed recurrence within 1 year. The presence of non-PV AF foci was a significant clinical predictor of AF recurrence after the second CA; successfully ablated non-PV AF foci increased the AF recurrence risk by 2.24 times (95% confidence interval [CI], 1.12-4.54; P = 0.02), and unmappable AF foci increased this risk by 5.58 times (95% CI, 2.73-11.63; P < 0.0001).
  
  
  CONCLUSIONS
  Nearly half of the patients had non-PV AF foci at the second CA session. AF recurred after the second CA session in approximately 30%, with most recurrences happening within 1 year. The presence of non-PV AF foci significantly increased the AF recurrence risk after a second CA. When non-PV AF foci were unmappable, the AF recurrence rate was extremely high.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.|Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.|Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okubo
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Emiko
authors.initials: E
authors.lastname: Nakashima
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watari
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikita
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; focal ablation; non-pulmonary vein foci; outcome; predictor; pulmonary vein isolation; recurrence