Non-Pulmonary Vein Foci Induced Before And After Pulmonary Vein Isolation In Patients Undergoing Ablation Therapy For Paroxysmal Atrial Fibrillation:Incidence And Clinical Outcome

ObjectiveTo evaluate incidence and clinical outcome of adenosine triphosphate (ATP)-plus isoproterenol (ISP)-induced non-pulmonary vein (PV) foci before and after circumferential PV isolation (CPVI) during index ablation in patients with paroxysmal atrial fibrillation (PAF).Methods and ResultsIn80consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April2010to Jan2011, AF was provoked with ATP (20mg) and ISP (20μg/min) administration before and after CPVI. Before ablation, AF mostly originating from PVs (51%vs.4%non-PV, p<0.01) was induced in39patients with sinus rhythm. CPVI significantly suppressed AF inducibility, however, more non-PV foci were provoked (17%vs4%, p=0.016). Patients with post-CPVI induced AF (n=49) were divided according to non-PV foci being induced (group N, n=17) or not (group P, n=32). After mean19.2±8.2months follow-up,88.2%(15/17) and65.6%(21/32) of patients in groups N and P, respectively, were free from AF recurrence (p=0.088).ConclusionATP+ISP administration effectively provokes non-PV foci, especially after CPVI in paroxysmal AF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.