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Effect of isolation feasibility of non-pulmonary vein foci on efficacy of ablation for atrial fibrillation: comparison of the isolation and focal ablation methods

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Abstract

Purpose

Atrial fibrillation (AF) mainly originates from the pulmonary vein (PV). However, some AF triggers originate from other sites, namely non-PV foci, which are related to recurrence after AF ablation. This study aimed to evaluate the effects of isolation feasibility (isolability) of non-PV foci on the efficacy of AF ablation.

Methods

Overall, 1855 patients with AF (age, 64.6 ± 10.9 years; 82% paroxysmal) underwent PV isolation, followed by induction and ablation of non-PV foci. Among them, 545 (29%) patients had non-PV foci; these patients were categorized into those with isolable non-PV foci (n = 196, 36%) and those with non-isolable non-PV foci (n = 349, 64%).

Results

During a mean follow-up of 31.2 ± 15.6 months, recurrence was higher in the non-isolable group than in the isolable group (34% vs. 19%, P < 0.01). Kaplan–Meier analyses revealed a significantly better 1-year clinical outcome in the isolable group than in the non-isolable group (88.0% vs. 78.4%, P < 0.001; hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.39–0.81). This outcome was not inferior to that of patients without non-PV foci (88.3% vs. 90.8%, P = 0.81). The non-isolable group showed poorer clinical outcomes than patients without non-PV foci (78.4% vs. 90.8%, P < 0.001; HR, 1.37; 95% CI, 1.22–1.53). Cox regression analysis revealed that isolability (HR, 0.56; 95% CI, 0.36–0.89) and unmappability (HR, 2.89; 95% CI, 1.55–5.37) of non-PV foci were significant predictors of arrhythmia recurrence.

Conclusion

The isolability of non-PV foci was a significant factor affecting the achievement of better clinical outcomes following AF ablation in patients with non-PV foci.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo To, 113-8510, Japan

    Takashi Ikenouchi, Yoshihide Takahashi, Masahiko Goya & Tetsuo Sasano

  2. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu-shi, Tokyo To, 183-0003, Japan

    Junichi Nitta

  3. Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-kuSaitama Prefecture, Saitama City, 330-8553, Japan

    Osamu Inaba, Toshikazu Kono, Kazuya Murata, Tomomasa Takamiya, Yukihiro Inamura, Akira Sato & Yutaka Matsumura

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  1. Takashi Ikenouchi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Takashi Ikenouchi, Toshikazu Kono, Kazuya Murata, Tomomasa Takamiya, Yukihiro Inamura, Akira Sato, and Osamu Inaba. Review and editing were performed by Akira Sato, Osamu Inaba, Junichi Nitta, Yutaka Matsumura, Yoshihide Takahashi, Masahiko Goya, and Tetsuo Sasano. The first draft of the manuscript was written by Takashi Ikenouchi, and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Takashi Ikenouchi.

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The study was approved by the Ethics Review Board of Japanese Red Cross Saitama Hospital (approval no: 20-AP). All patients provided written informed consent.

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The authors declare no competing interests.

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Ikenouchi, T., Nitta, J., Inaba, O. et al. Effect of isolation feasibility of non-pulmonary vein foci on efficacy of ablation for atrial fibrillation: comparison of the isolation and focal ablation methods. J Interv Card Electrophysiol 65, 441–451 (2022). https://doi.org/10.1007/s10840-022-01217-w

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