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Review
. 2018 Dec;7(4):256-260.
doi: 10.15420/aer.2018.56.2.

Percutaneous Treatment of Non-paroxysmal Atrial Fibrillation: A Paradigm Shift from Pulmonary Vein to Non-pulmonary Vein Trigger Ablation?

Domenico G Della Rocca  1 , Sanghamitra Mohanty  1 , Chintan Trivedi  1 , Luigi Di Biase  1   2   3 , Andrea Natale  1   4   5   6
Affiliations
Review

Percutaneous Treatment of Non-paroxysmal Atrial Fibrillation: A Paradigm Shift from Pulmonary Vein to Non-pulmonary Vein Trigger Ablation?

Domenico G Della Rocca et al. Arrhythm Electrophysiol Rev. 2018 Dec.

Abstract

Pulmonary vein antrum isolation is the most effective rhythm control strategy in patients with paroxysmal AF. However, catheter ablation of non-paroxysmal AF has a lower success rate, even when persistent isolation of pulmonary veins (PVs) is achieved. As a result of arrhythmia-related electophysiological and structural changes in the atria, sites other than the PVs can harbour triggers. These non-PV triggers contribute to AF relapse. In this article, we summarise the rationale and current evidence supporting the arrhythmogenic role of non-PV triggers and our ablation approach to patients with non-paroxysmal AF.

Keywords: Atrial fibrillation; catheter ablation; non-pulmonary vein trigger; outcomes.

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Conflict of interest statement

Disclosure: Luigi Di Biase is a consultant for Biosense Webster, Boston Scientific, Stereotaxis and St Jude Medical; and has received speaker honoraria from Medtronic, Atricure, EPiEP and Biotronik. Andrea Natale has received speaker honoraria from Boston Scientific, Biosense Webster, St Jude Medical, Biotronik and Medtronic; and is a consultant for Biosense Webster, St Jude Medical and Janssen. All other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Standard Catheter Set-up
Figure 2:
Figure 2:. Activation in the Distal Duo-decapolar Catheter for Ectopic Bets Originating from the Coronary Sinus
Figure 3:
Figure 3:. Far-field Activity Recorded from the Circular Mapping Catheter before the Distal Coronary Sinus for Beats Originating from the Left Atrial Appendage
See this image and copyright information in PMC

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