Impact of diagnosis‐to‐ablation time on non‐pulmonary vein triggers and ablation outcomes in persistent atrial fibrillation

Introduction Non‐pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis‐to‐ablation time (DAT) on non‐PV triggers in persistent atrial fibrillation is unknown. Methods and Results This observational stud...

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Published in:	Journal of cardiovascular electrophysiology Vol. 32; no. 5; pp. 1251 - 1258
Main Authors:	Takamiya, Tomomasa, Nitta, Junichi, Inaba, Osamu, Sato, Akira, Inamura, Yukihiro, Murata, Kazuya, Ikenouchi, Takashi, Kono, Toshikazu, Takahashi, Yoshihide, Goya, Masahiko, Sasano, Tetsuo
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01.05.2021
Subjects:	Ablation atrial fibrillation Cardiac arrhythmia catheter ablation Catheters Diagnosis diagnosis‐to‐ablation time duration Fibrillation Multivariate analysis non‐pulmonary vein foci non‐pulmonary vein triggers posterior wall isolation Sex ratio Tachyarrhythmia duration posterior wall isolation atrial fibrillation catheter ablation diagnosis-to-ablation time non-pulmonary vein foci non-pulmonary vein triggers
ISSN:	1045-3873, 1540-8167, 1540-8167
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Abstract	Introduction Non‐pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis‐to‐ablation time (DAT) on non‐PV triggers in persistent atrial fibrillation is unknown. Methods and Results This observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non‐PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non‐PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow‐up of 770 days, the ATA recurrence‐free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year, p = .008) were predictors of non‐PV AF/AT triggers, and a longer DAT (hazard ratio: 1.12/year, p < .001) and non‐PV AT/AF triggers (hazard ratio: 1.79, p = .009) were associated with ATA recurrence. Conclusion Early ablation after the first diagnosis of persistent AF may reduce emerging non‐PV AF/AT triggers and ATA recurrence.
AbstractList	IntroductionNon‐pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis‐to‐ablation time (DAT) on non‐PV triggers in persistent atrial fibrillation is unknown.Methods and ResultsThis observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non‐PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non‐PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow‐up of 770 days, the ATA recurrence‐free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year, p = .008) were predictors of non‐PV AF/AT triggers, and a longer DAT (hazard ratio: 1.12/year, p < .001) and non‐PV AT/AF triggers (hazard ratio: 1.79, p = .009) were associated with ATA recurrence.ConclusionEarly ablation after the first diagnosis of persistent AF may reduce emerging non‐PV AF/AT triggers and ATA recurrence. Non-pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis-to-ablation time (DAT) on non-PV triggers in persistent atrial fibrillation is unknown.INTRODUCTIONNon-pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis-to-ablation time (DAT) on non-PV triggers in persistent atrial fibrillation is unknown.This observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non-PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non-PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow-up of 770 days, the ATA recurrence-free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year, p = .008) were predictors of non-PV AF/AT triggers, and a longer DAT (hazard ratio: 1.12/year, p < .001) and non-PV AT/AF triggers (hazard ratio: 1.79, p = .009) were associated with ATA recurrence.METHODS AND RESULTSThis observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non-PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non-PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow-up of 770 days, the ATA recurrence-free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year, p = .008) were predictors of non-PV AF/AT triggers, and a longer DAT (hazard ratio: 1.12/year, p < .001) and non-PV AT/AF triggers (hazard ratio: 1.79, p = .009) were associated with ATA recurrence.Early ablation after the first diagnosis of persistent AF may reduce emerging non-PV AF/AT triggers and ATA recurrence.CONCLUSIONEarly ablation after the first diagnosis of persistent AF may reduce emerging non-PV AF/AT triggers and ATA recurrence. Non-pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis-to-ablation time (DAT) on non-PV triggers in persistent atrial fibrillation is unknown. This observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non-PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non-PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow-up of 770 days, the ATA recurrence-free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year, p = .008) were predictors of non-PV AF/AT triggers, and a longer DAT (hazard ratio: 1.12/year, p < .001) and non-PV AT/AF triggers (hazard ratio: 1.79, p = .009) were associated with ATA recurrence. Early ablation after the first diagnosis of persistent AF may reduce emerging non-PV AF/AT triggers and ATA recurrence. Introduction Non‐pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis‐to‐ablation time (DAT) on non‐PV triggers in persistent atrial fibrillation is unknown. Methods and Results This observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non‐PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non‐PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow‐up of 770 days, the ATA recurrence‐free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year, p = .008) were predictors of non‐PV AF/AT triggers, and a longer DAT (hazard ratio: 1.12/year, p < .001) and non‐PV AT/AF triggers (hazard ratio: 1.79, p = .009) were associated with ATA recurrence. Conclusion Early ablation after the first diagnosis of persistent AF may reduce emerging non‐PV AF/AT triggers and ATA recurrence.
Author	Takahashi, Yoshihide Goya, Masahiko Sato, Akira Nitta, Junichi Murata, Kazuya Inaba, Osamu Kono, Toshikazu Ikenouchi, Takashi Inamura, Yukihiro Takamiya, Tomomasa Sasano, Tetsuo
Author_xml	– sequence: 1 givenname: Tomomasa orcidid: 0000-0002-3804-2332 surname: Takamiya fullname: Takamiya, Tomomasa email: takatomo@castle.ocn.ne.jp organization: Japanese Red Cross Saitama Hospital – sequence: 2 givenname: Junichi surname: Nitta fullname: Nitta, Junichi organization: Sakakibara Heart Institute – sequence: 3 givenname: Osamu orcidid: 0000-0003-2179-3786 surname: Inaba fullname: Inaba, Osamu – sequence: 4 givenname: Akira surname: Sato fullname: Sato, Akira organization: Japanese Red Cross Saitama Hospital – sequence: 5 givenname: Yukihiro orcidid: 0000-0002-7027-2613 surname: Inamura fullname: Inamura, Yukihiro organization: Japanese Red Cross Saitama Hospital – sequence: 6 givenname: Kazuya surname: Murata fullname: Murata, Kazuya organization: Japanese Red Cross Saitama Hospital – sequence: 7 givenname: Takashi surname: Ikenouchi fullname: Ikenouchi, Takashi organization: Japanese Red Cross Saitama Hospital – sequence: 8 givenname: Toshikazu surname: Kono fullname: Kono, Toshikazu organization: Japanese Red Cross Saitama Hospital – sequence: 9 givenname: Yoshihide orcidid: 0000-0003-0335-996X surname: Takahashi fullname: Takahashi, Yoshihide organization: Tokyo Medical and Dental University – sequence: 10 givenname: Masahiko surname: Goya fullname: Goya, Masahiko organization: Tokyo Medical and Dental University – sequence: 11 givenname: Tetsuo orcidid: 0000-0003-3582-6104 surname: Sasano fullname: Sasano, Tetsuo organization: Tokyo Medical and Dental University
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Keywords	duration posterior wall isolation atrial fibrillation catheter ablation diagnosis-to-ablation time non-pulmonary vein foci non-pulmonary vein triggers
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Snippet	Introduction Non‐pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the... Non-pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the... IntroductionNon‐pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the...
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SubjectTerms	Ablation atrial fibrillation Cardiac arrhythmia catheter ablation Catheters Diagnosis diagnosis‐to‐ablation time duration Fibrillation Multivariate analysis non‐pulmonary vein foci non‐pulmonary vein triggers posterior wall isolation Sex ratio Tachyarrhythmia
Title	Impact of diagnosis‐to‐ablation time on non‐pulmonary vein triggers and ablation outcomes in persistent atrial fibrillation
URI	https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fjce.15002 https://www.ncbi.nlm.nih.gov/pubmed/33713521 https://www.proquest.com/docview/2525155590 https://www.proquest.com/docview/2501266496
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