Author + information
- Received June 13, 2016
- Revision received November 9, 2016
- Accepted December 8, 2016
- Published online June 19, 2017.
- Rintaro Hojo, MDa,∗ (, )
- Seiji Fukamizu, MDa,
- Takeshi Kitamura, MDa,
- Yuya Aomyama, MD, PhDa,
- Mitsuhiro Nishizaki, MD, PhDb,
- Yoichi Kobayashi, MD, PhDc,
- Harumizu Sakurada, MD, PhDd and
- Masayasu Hiraoka, MD, PhDe
- aDepartment of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- bDepartment of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
- cDepartment of Cardiology, Showa University School of Medicine Hospital, Tokyo, Japan
- dTokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
- eTokyo Medical and Dental University, Tokyo, Japan
- ↵∗Address for correspondence:
Dr. Rintaro Hojo, Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan.
Objectives The aim of this paper was to clarify the impact of nonpulmonary vein foci (NPVF) on atrial fibrillation (AF) recurrence after pulmonary vein (PV) isolation.
Background NPVF are considered contributing factors for the recurrence of AF after PV isolation, but their exact role remains unclear.
Methods We retrospectively reviewed 216 patients (paroxysmal AF, n = 172; persistent AF, n = 44) who underwent a second electrophysiological study 6 months after the original PV isolation. Patients with AF recurrence underwent additional ablation procedures for reconnected PV and NPVF. NPVF were detected in the control group and with drug infusion (isoproterenol or isoproterenol with adenosine triphosphate) during the first and second procedure. NPVF detected for the first time in the second session were defined as newly developed, and their effect on AF recurrence after the second procedure was investigated, along with the predictive factors for NPVF development.
Results Patients with AF recurrence after the first session had a significantly higher reconnected PV (91.5% vs. 68.2% in patients without recurrence). NPVF were detected in 20 and 54 patients in the first and second sessions, respectively. Patients with newly developed NPVF had a significantly higher AF recurrence (24.1% vs. 7.4% in patients without newly developed NPVF). Newly developed NPVF and AF recurrence after the first session were independent predictors for AF recurrence after the second procedure, whereas AF history and NPVF in the first session were independent predictors for newly developed NPVF.
Conclusions NPVF detection and ablation may represent important therapeutic options to prevent AF recurrence, especially in patients who require repeated procedures.
- adenosine triphosphate
- atrial fibrillation
- nonpulmonary vein foci
- pulmonary vein isolation
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 13, 2016.
- Revision received November 9, 2016.
- Accepted December 8, 2016.
- 2017 American College of Cardiology Foundation