Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Experimental methods D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-176 - The Efficacy Of Non-pulmonary Vein Triggers Ablation After Pulmonary Vein Isolation With Cryoballoon For Atrial Fibrillation Patients (ID 129)


Background: Pulmonary vein isolation (PVI) with cryoballoon (CB) catheter is an effective treatment for atrial fibrillation (AF). However, it has been recognized that not only the electrical firing from pulmonary vein but non-pulmonary vein (PV) triggers can also initiate AF, which may leads to poor clinical outcome of PVI. There are scarce data about the efficacy of additional ablation for non-PV trigger after the CB ablation.
Objective: This study is to analyze the clinical outcomes of non-PV trigger ablation after PVI with CB.
Methods: A total of 1756 AF patients (age 65.7±47.8; 1156 males; 1423 paroxysmal AF) underwent their first CB-PVI from September 2014 to July 2019. Induction of non-PV trigger by using isoproterenol infusion and rapid atrial pacing, followed by ablation with radiofrequency catheter if trigger exits, were performed in all patients after PVI was completed. Patients were divided into six groups based on their origin of non-PV trigger; (A) none, (B) only from right atrium (RA), (C) only from left atrium (LA), (D) only from interatrial septum (IAS), (E) multiple foci, (F) unmapplable.
Results: Non-PV triggers were induced and ablated in 509 (29%) patients in total. The number of patients in each group were 1221 (A; 70%), 270 (B; 15%), 53 (C; 3%), 40 (D; 2%), 108 (E; 6%), and 46 (F; 3%). The mean follow-up period was 23.5±13.6 months (range 1-59) after the procedure. Kaplan-Meier analysis revealed that there were no significant difference in 1-year AF/AT free survival rate between group A and B (90% vs 86%, p=0.27), A and C (90% vs 80%, p=0.46), and A and D (90% vs 92%, p=0.54). Patients in group E and F suffered from significantly high AF/AT recurrence rate compared to group A (28% vs 10%, p<0.001; 26% vs 10%, p<0.001) one year after the procedure. Multivariable Cox regression analysis revealed that non-PV triggers from multiple area (p=0.001, OR=2.43) and unmappable (p<0.001, OR=2.78), were the independent significant predictors of AF/AT recurrence after the procedure.
Conclusion: Additional non-PV trigger ablation after CB-PVI might be effective for patients with those originated only from one side of heart or IAS. Non-PV triggers from multiple area and unmappable triggers were significantly associated with AF/AT recurrence after ablation.