title: Importance of nonpulmonary vein foci in catheter ablation for paroxysmal atrial fibrillation.
abstract: BACKGROUND
  Pulmonary vein (PV) isolation is an established treatment strategy for paroxysmal atrial fibrillation (PAF). However, the recurrence rate of PAF is 8% to 37%, despite repeated procedures, and the catheter ablation strategy for PAF with non-PV foci is unclear.
  
  
  OBJECTIVE
  The purpose of this study was to assess the PAF ablation strategy for non-PV foci.
  
  
  METHODS
  The study included 304 consecutive patients undergoing PAF ablation (209 males, age 63.0 ± 10.4 years) divided into 3 groups: group 1 (245 patients) with no inducible non-PV foci; group 2 (34 patients) with atrial fibrillation (AF) originating from non-PV foci and all the foci successfully ablated; and group 3 (25 patients) with AF originating from non-PV triggers, but without all foci being ablated or with persistently inducible AF.
  
  
  RESULTS
  Mean follow-up period was 26.9 ± 11.8 months, and AF recurrence rates since the last procedure were 9.8%, 8.8%, and 68.0% in groups 1, 2, and 3, respectively. There was no statistically significant difference in recurrence rate between groups 1 and 2 (P = .89); however, there were statistically significant differences between groups 3 and 1 (P <.0001) and groups 3 and 2 (P <.0001). The patients in group 2 had an AF-free outcome to equivalent to those who had PV foci in group 1 (P = .83).
  
  
  CONCLUSIONS
  Success rates can be improved for PAF ablation if non-PV foci are detected and eliminated.
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. Electronic address: sg-kentaro@kf6.so-net.ne.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Yoshimori
authors.initials: Y
authors.lastname: An
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Nagashima
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hiroshima
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Ohe
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Makihara
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Kennosuke
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Schoichiro
authors.initials: S
authors.lastname: Yamazato
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Fukunaga
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Sonoda
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Goya
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Mapping; Nonpulmonary vein foci; Pulmonary vein isolation