• Masateru Takigawa, Atsushi Takahashi, Taishi Kuwahara, Kenji Okubo, Yoshihide Takahashi, Emiko Nakashima, Yuji Watari, Kazuya Yamao, Jun Nakajima, Katsumasa Takagi, Shigeki Kimura, Hiroyuki Hikita, Kenzo Hirao, and Mitsuaki Isobe.
• Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
• J. Cardiovasc. Electrophysiol. 2015 Jul 1; 26 (7): 739-46.

BackgroundParoxysmal atrial fibrillation (AF) is primarily triggered by pulmonary veins (PVs). However, non-PV AF foci may also trigger AF.MethodsWe examined 207 patients (mean age, 62 ± 11 years; 166 men) who underwent a second catheter ablation (CA) and evaluated the clinical significance of non-PV AF foci on the outcomes.ResultsElectrical reconnections between the PVs and left atrium (LA) were observed in 162 patients (78.3%). Non-PV AF foci were identified in 95 patients (45.9%, 60 patients with successfully ablated non-PV AF foci and 35 with unmappable non-PV AF foci). During a median follow-up period of 22.7 months, 61 patients (29.5%; 18/112 [16.1%] without non-PV AF foci vs. 20/60 [33.3%] with successfully ablated non-PV AF foci vs. 23/35 [65.7%] with unmappable non-PV AF foci, P < 0.0001) developed AF recurrence; 52 (85.2%) developed recurrence within 1 year. The presence of non-PV AF foci was a significant clinical predictor of AF recurrence after the second CA; successfully ablated non-PV AF foci increased the AF recurrence risk by 2.24 times (95% confidence interval [CI], 1.12-4.54; P = 0.02), and unmappable AF foci increased this risk by 5.58 times (95% CI, 2.73-11.63; P < 0.0001).ConclusionNearly half of the patients had non-PV AF foci at the second CA session. AF recurred after the second CA session in approximately 30%, with most recurrences happening within 1 year. The presence of non-PV AF foci significantly increased the AF recurrence risk after a second CA. When non-PV AF foci were unmappable, the AF recurrence rate was extremely high.© 2015 Wiley Periodicals, Inc.

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