Author + information
- Received February 11, 2019
- Revision received July 29, 2019
- Accepted August 6, 2019
- Published online November 18, 2019.
- Ryo Nakamaru, MDa,b,
- Masato Okada, MDa,
- Nobuaki Tanaka, MDa,
- Koji Tanaka, MDa,
- Yuichi Ninomiya, MD, PhDa,
- Yuko Hirao, MDa,
- Takafumi Oka, MD, PhDa,
- Hiroyuki Inoue, MDa,
- Kohtaro Takayasu, MDa,
- Yasushi Koyama, MD, PhDa,
- Atsunori Okamura, MD, PhDa,
- Katsuomi Iwakura, MD, PhDa,
- Hiromi Rakugi, MD, PhDb,
- Yasushi Sakata, MD, PhDc,
- Kenshi Fujii, MD, PhDa and
- Koichi Inoue, MD, PhDa,∗ ()
- aDepartment of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
- bDepartment of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- cDepartment of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- ↵∗Address for correspondence:
Dr. Koichi Inoue, Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 5300001, Japan.
Objectives The aim of this study was to examine the relationship between residual premature atrial contractions (PACs) originating from non-pulmonary veins (PVs), which do not initiate atrial fibrillation (AF), and AF recurrence after ablation.
Background Residual atrial ectopic beats that trigger AF from non-PVs (non-PV AF triggers) after catheter ablation are among the major causes of AF recurrence. However, little is known about the impact of non-PV PACs on AF recurrence.
Methods This retrospective study included 565 consecutive patients who underwent first-time AF ablation at our institution. After PV isolation, we infused isoproterenol to provoke non-PV AF triggers and/or non-PV PACs. We excluded 26 patients with non-PV AF triggers and 3 patients who underwent ablation of non-PV PACs, and finally analyzed 536 patients. Non-PV PACs were defined as ectopic beats that were constantly observed with the same intra-atrial activation patterns from non-PVs.
Results Residual non-PV PACs during the procedure were observed in 112 patients (21%). There was no significant difference in the AF recurrence rate between patients with non-PV PACs (35 of 112, 31%) and those without (145 of 424, 34%; log-rank p = 0.69), during a median follow-up of 670 days. Age- and sex-adjusted hazards for AF recurrence were also similar between the 2 groups.
Conclusions The similar AF recurrence rate in patients with and without non-PV PACs suggests that the additional ablation of non-PV PACs has limited effect on AF recurrence.
This research received no grants from any funding agency in the public, commercial, or not-for-profit sectors. Dr. Inoue has received honoraria from Johnson and Johnson KK, Medtronic Japan, Bayer Yakuhin, Nihon Boehringer Ingelheim, Bristol-Myers Squibb, and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 February 11, 2019.
- Revision received July 29, 2019.
- Accepted August 6, 2019.
- 2019 American College of Cardiology Foundation
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