Nonpulmonary Foci After Pulmonary Vein Isolation

Study Questions:

How do nonpulmonary vein foci (NPVF) affect outcomes after pulmonary vein isolation (PVI)?


This was a retrospective analysis of 216 patients who underwent a second electrophysiology procedure 6 months after radiofrequency catheter ablation (RFCA; PVI and ablation of NPVF) for paroxysmal (n = 172 patients) or persistent (n = 44) atrial fibrillation (AF). This procedure was performed regardless of the clinical outcome of the first procedure. NPVF were provoked by isoproterenol and/or adenosine infusion. NPVF detected for the first time during the second procedure were defined as new NPVF. Serial 24-hour Holter monitors were performed during up to 24 months of follow-up.


At the time of the second electrophysiology procedure, 59/216 patients (27%) had had recurrent AF. Among these patients, 91.5% demonstrated a recurrence of PV conduction, and new NPVF were found in 33.9%. Among the patients without AF recurrence, 68.2% had reconnected PVs and 21.7% had NPVF. After the second ablation procedure, the AF recurrence rate was significantly higher among the patients with NPVF (24%) than in patients without NPVF (7.4%). NPVF during the first procedure was an independent predictor of NPVF during the second procedure.


The authors concluded that NPVF are a predictor of AF recurrence after redo RFCA in patients with AF.


The authors also concluded that ablation of NPVF is important in patients undergoing redo RFCA for AF. Although this is plausible and consistent with the findings of several prior studies, the present study provides no evidence for this conclusion. Because RFCA of NPVF always was attempted and there was no control group, these is no evidence that this strategy had incremental clinical value.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Adenosine, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Electrocardiography, Electrophysiology, Isoproterenol, Pulmonary Veins, Recurrence, Secondary Prevention

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