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Clinical Impact of Eliminating Non-Pulmonary Vein Triggers in Patients with Persistent Atrial Fibrillation: Highlights on Non-Pulmonary Vein Foci and Premature Atrial Contraction
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  • Shota Tohoku,
  • Masato Fukunaga,
  • Michio Nagashima,
  • Jun Hirokami,
  • Kengo Korai,
  • Kei Yamamoto,
  • Harushi Niu,
  • Ayaka Takeo,
  • Kenji Ando,
  • Kenichi Hiroshima
Shota Tohoku
Kokura Memorial Hospital
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Masato Fukunaga
Kokura Memorial Hospital
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Michio Nagashima
Kokura Memorial Hospital
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Jun Hirokami
Kokura Memorial Hospital
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Kengo Korai
Kokura Memorial Hospital
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Kei Yamamoto
Kokura Memorial Hospital
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Harushi Niu
Kokura Memorial Hospital
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Ayaka Takeo
Kokura Memorial Hospital
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Kenji Ando
Kokura Memorial Hospital
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Kenichi Hiroshima
Kokura Memorial Hospital
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Abstract

Backgrounds: The role of non-pulmonary vein (PV) triggers ablation in persistent atrial fibrillation (PEAF) was suggested but it is still under debate. Objectives: We aimed to assess the effectiveness of non-PV trigger targeted ablation for patients with PEAF. Methods: Consecutive patients with PEAF undergoing catheter ablation (CA) between January 2015 and April 2017 were enrolled. Isoproterenol plus adenosine challenge was performed to provoke non-PV triggers. Non-PV triggers were defined as the non-PV foci inducing AF and/or frequent premature contraction (non-PV PAC) from other than PVs. Three groups were defined: group 1 (n=186) without non-PV triggers; group 2 (n=65) with non-PV triggers that could be completely eliminated with CA; group 3 (n=49) with non-PV triggers still inducible after CA. Primary endpoint was freedom from any atrial tachyarrhythmia (ATa) recurrence. Results: A total of 300 patients (230 males, age 64±10) were enrolled. Mean follow-up period was 27±10 months. Freedom from ATa recurrence at 1- and 2 years were significantly lower in group 3 compared to the other 2 groups (group 1; 74.7%, 67.2% vs. group 2; 75.8%, 68.3% vs. group 3: 52.1%, 38.6%, P=0.0005), irrespective of the type of non-PV triggers (non-PV PAC vs. non-PV foci initiating AF). On multivariate analysis, unsuccessful elimination of non-PV trigger was an independent predictor for ATa recurrence (HR 1.80 [95%CI:1.07-2.93], P=0.026). Conclusions: Successful non-PV trigger elimination can improve the ATa recurrence rate in PEAF ablation. ATa recurrence rate is higher, if non-PV foci or even non-PV PAC remains in patients with PEAF.

Peer review status:UNDER REVIEW

25 Jun 2020Submitted to Journal of Cardiovascular Electrophysiology
25 Jun 2020Submission Checks Completed
25 Jun 2020Assigned to Editor
28 Jun 2020Reviewer(s) Assigned
13 Jul 2020Review(s) Completed, Editorial Evaluation Pending
18 Jul 2020Editorial Decision: Revise Minor
23 Aug 20201st Revision Received
24 Aug 2020Submission Checks Completed
24 Aug 2020Assigned to Editor
24 Aug 2020Reviewer(s) Assigned
07 Sep 2020Review(s) Completed, Editorial Evaluation Pending
08 Sep 2020Editorial Decision: Revise Minor
24 Sep 20202nd Revision Received
25 Sep 2020Assigned to Editor
25 Sep 2020Submission Checks Completed
25 Sep 2020Reviewer(s) Assigned