Nonpulmonary vein foci: do they exist?

Dipen Shah, Michel Haissaguerre, Pierre Jais, Meleze Hocini
Pacing and Clinical Electrophysiology: PACE 2003, 26 (7): 1631-5
Though the majority of foci triggering atrial fibrillation (AF) have been mapped to the pulmonary veins (PV), recurrence of paroxysmal AF after isolation of all four pulmonary veins indicates the presence of other foci. In a series of 160 consecutive patients who underwent PV ablation, endocardial mapping of AF and ectopy recurring after PV isolation was performed. Thirty-six patients (24%) had a total of 85 non-PV foci; 39 were mapped to the ostia of ablated PVs, 30 to the posterior left atrium (LA), 5 to other parts of the LA, 5 to the right atrium (RA), 4 to the coronary sinus (CS), and 3 to the superior vena cava (SVC) (including one persistent left SVC). Mapping was confirmed by successful ablation. At least 16 foci could not be localized and after a follow-up of 8 +/- 6 months, 68% of patients were free of AF without any antiarrhythmic treatment. The occurrence of non-PV foci correlated with recurrence of AF, perhaps as a correlate of insufficient ostial ablation. These data reinforce the requirement for more proximal disconnection of the PVs by performing ablation within the LA. In patients with non-PV foci that are difficult to map conventionally, the use of surface ECG data, or multielectrode contact or noncontact mapping arrays, or substrate modifying/excluding ablation may be helpful in ablating these foci and therefore eliminating AF.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"