Cargando…
Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium
The pathophysiology of non-pulmonary vein (PV) triggers of atrial fibrillation (AF) is unclear. We hypothesized that left atrial non-PV (LANPV) triggers are associated with atrial tissue degeneration. This study analyzed 431 patients that underwent catheter ablation (mean age 62 yrs, 303 men, 255 pa...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706423/ https://www.ncbi.nlm.nih.gov/pubmed/31439861 http://dx.doi.org/10.1038/s41598-019-48669-1 |
_version_ | 1783445698938667008 |
---|---|
author | Kawai, Shunsuke Mukai, Yasushi Inoue, Shujiro Yakabe, Daisuke Nagaoka, Kazuhiro Sakamoto, Kazuo Takase, Susumu Chishaki, Akiko Tsutsui, Hiroyuki |
author_facet | Kawai, Shunsuke Mukai, Yasushi Inoue, Shujiro Yakabe, Daisuke Nagaoka, Kazuhiro Sakamoto, Kazuo Takase, Susumu Chishaki, Akiko Tsutsui, Hiroyuki |
author_sort | Kawai, Shunsuke |
collection | PubMed |
description | The pathophysiology of non-pulmonary vein (PV) triggers of atrial fibrillation (AF) is unclear. We hypothesized that left atrial non-PV (LANPV) triggers are associated with atrial tissue degeneration. This study analyzed 431 patients that underwent catheter ablation (mean age 62 yrs, 303 men, 255 paroxysmal AF [pAF] patients). Clinical and electrophysiological characteristics of non-PV trigger were analyzed. Fifty non-PV triggers in 40 patients (9.3%) were documented; LANPV triggers were the most prevalent (n = 19, 38%). LANPV triggers were correlated with non-paroxysmal AF (non-pAF) (OR 3.31, p = 0.04) whereas right atrial non-PV (RANPV) triggers (n = 14) and SVC triggers (n = 17) were not. The voltage at the LANPV sites during SR was 0.3 ± 0.16 mV (p < 0.001 vs. control site). Low-voltage areas (LVAs) in the LA were significantly greater in non-pAF compared to pAF (14.2% vs. 5.8%, p < 0.01). RANPV trigger sites had preserved voltage (0.74 ± 0.48 mV). Long-term outcomes of patients with non-PV triggers treated with tailored targeting strategies were not significantly inferior to those without non-PV triggers. In conclusion, non-PV triggers arise from the LA with degeneration, which may have an important role in AF persistence. A trigger-oriented, patient-tailored ablation strategy considering LA voltage map may be feasible and effective in persistent/recurrent AF. |
format | Online Article Text |
id | pubmed-6706423 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-67064232019-09-08 Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium Kawai, Shunsuke Mukai, Yasushi Inoue, Shujiro Yakabe, Daisuke Nagaoka, Kazuhiro Sakamoto, Kazuo Takase, Susumu Chishaki, Akiko Tsutsui, Hiroyuki Sci Rep Article The pathophysiology of non-pulmonary vein (PV) triggers of atrial fibrillation (AF) is unclear. We hypothesized that left atrial non-PV (LANPV) triggers are associated with atrial tissue degeneration. This study analyzed 431 patients that underwent catheter ablation (mean age 62 yrs, 303 men, 255 paroxysmal AF [pAF] patients). Clinical and electrophysiological characteristics of non-PV trigger were analyzed. Fifty non-PV triggers in 40 patients (9.3%) were documented; LANPV triggers were the most prevalent (n = 19, 38%). LANPV triggers were correlated with non-paroxysmal AF (non-pAF) (OR 3.31, p = 0.04) whereas right atrial non-PV (RANPV) triggers (n = 14) and SVC triggers (n = 17) were not. The voltage at the LANPV sites during SR was 0.3 ± 0.16 mV (p < 0.001 vs. control site). Low-voltage areas (LVAs) in the LA were significantly greater in non-pAF compared to pAF (14.2% vs. 5.8%, p < 0.01). RANPV trigger sites had preserved voltage (0.74 ± 0.48 mV). Long-term outcomes of patients with non-PV triggers treated with tailored targeting strategies were not significantly inferior to those without non-PV triggers. In conclusion, non-PV triggers arise from the LA with degeneration, which may have an important role in AF persistence. A trigger-oriented, patient-tailored ablation strategy considering LA voltage map may be feasible and effective in persistent/recurrent AF. Nature Publishing Group UK 2019-08-22 /pmc/articles/PMC6706423/ /pubmed/31439861 http://dx.doi.org/10.1038/s41598-019-48669-1 Text en © The Author(s) 2019 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Kawai, Shunsuke Mukai, Yasushi Inoue, Shujiro Yakabe, Daisuke Nagaoka, Kazuhiro Sakamoto, Kazuo Takase, Susumu Chishaki, Akiko Tsutsui, Hiroyuki Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium |
title | Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium |
title_full | Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium |
title_fullStr | Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium |
title_full_unstemmed | Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium |
title_short | Non-Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise from Low-Voltage Areas in the Left Atrium |
title_sort | non-pulmonary vein triggers of atrial fibrillation are likely to arise from low-voltage areas in the left atrium |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706423/ https://www.ncbi.nlm.nih.gov/pubmed/31439861 http://dx.doi.org/10.1038/s41598-019-48669-1 |
work_keys_str_mv | AT kawaishunsuke nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium AT mukaiyasushi nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium AT inoueshujiro nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium AT yakabedaisuke nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium AT nagaokakazuhiro nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium AT sakamotokazuo nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium AT takasesusumu nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium AT chishakiakiko nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium AT tsutsuihiroyuki nonpulmonaryveintriggersofatrialfibrillationarelikelytoarisefromlowvoltageareasintheleftatrium |