Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025
The prevalence, distribution and ablation of non-pulmonary vein triggers in older patients with paroxysmal atrial fibrillation.
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Wu Song, Chen Zhenye, Li Zhaomin, Sun Xingxing, Tao Zhengxian, Li Xianlun, Chen Hongwu, Chen Minglong
Аннотация
OBJECTIVES: To investigate the prevalence, distribution and ablation of non-pulmonary vein (PV) triggers in older patients with paroxysmal atrial fibrillation (AF).
METHODS: A total of 694 patients aged 65-80 receiving index ablation for paroxysmal AF were included. These patients were divided as follows: patients without low-voltage areas (LVA) (n = 437), LVA patients with modification (n = 175), and LVA patients without modification (n = 82). Following propensity score matching (PSM) analysis, two sets of matched groups emerged: LVA patients without modification (Group A, n = 77) and patients without LVA (Group B, n = 77), and patients without LVA (Group C, n = 168) and LVA patients with modification (Group D, n = 168). The clinical endpoint was defined as the detection of ATA lasting longer than 30 s through ECG documentation or Holter recordings following the index ablation.
RESULTS: Fifty-seven (8.2%) patients were identified with non-PV triggers, mostly originating from superior vena cava (SVC). Compared with Group A, Group B exhibited a higher prevalence of non-PV triggers (18.2% vs. 6.5%, p = 0.027). Likewise, Group C showed a higher prevalence compared with Group D (14.3% vs 7.1%, p = 0.034). Over a mean follow-up of 19.7 months, there was no significant difference in ATA recurrence between patients with non-PV triggers ablation (n = 57) and without non-PV triggers (n = 637) (71.9% vs 74.9%, p = 0.458).
CONCLUSIONS: Among older patients with paroxysmal AF, non-PV triggers exhibit a lower prevalence, originate mostly from SVC, and present less frequently in patients with LVA.
METHODS: A total of 694 patients aged 65-80 receiving index ablation for paroxysmal AF were included. These patients were divided as follows: patients without low-voltage areas (LVA) (n = 437), LVA patients with modification (n = 175), and LVA patients without modification (n = 82). Following propensity score matching (PSM) analysis, two sets of matched groups emerged: LVA patients without modification (Group A, n = 77) and patients without LVA (Group B, n = 77), and patients without LVA (Group C, n = 168) and LVA patients with modification (Group D, n = 168). The clinical endpoint was defined as the detection of ATA lasting longer than 30 s through ECG documentation or Holter recordings following the index ablation.
RESULTS: Fifty-seven (8.2%) patients were identified with non-PV triggers, mostly originating from superior vena cava (SVC). Compared with Group A, Group B exhibited a higher prevalence of non-PV triggers (18.2% vs. 6.5%, p = 0.027). Likewise, Group C showed a higher prevalence compared with Group D (14.3% vs 7.1%, p = 0.034). Over a mean follow-up of 19.7 months, there was no significant difference in ATA recurrence between patients with non-PV triggers ablation (n = 57) and without non-PV triggers (n = 637) (71.9% vs 74.9%, p = 0.458).
CONCLUSIONS: Among older patients with paroxysmal AF, non-PV triggers exhibit a lower prevalence, originate mostly from SVC, and present less frequently in patients with LVA.