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Predictors of non-pulmonary vein foci in paroxysmal atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary vein treatment; predicting non-PV foci in advance is important to decide the treatment strategy. In this study, we investigate the predictors for paroxysmal AF.

Methods

Subjects were consecutive paroxysmal AF patients who underwent high-dose isoproterenol provocation after PV isolation in the first session. The PV group (n = 102) and non-PV group (n = 222) were defined as the patients with and without non-PV ablation, respectively. Non-PV ablation was performed when frequent repetitive premature atrial contractions or triggered AF occurred spontaneously or by isoproterenol provocation. Predictors of non-PV origin in paroxysmal AF patients were examined using clinical characteristics and preoperative echocardiography.

Results

In the multivariate logistic regression analysis, female sex, body mass index (BMI < 23.8), absence of hypertension, and higher ratio of mitral early diastolic peak (E-wave) to early diastolic mitral annulus peak (e’) velocity (E/e’ > 8.44) were significant independent predictors of non-PV foci (hazard ratio 2.04, 1.88, 3.63, and 2.33; 95% confidence interval 1.17–3.55, 1.05–3.39, 1.72–7.67, and 1.34–4.05; p = 0.011, 0.035, < 0.001, and 0.003, respectively). If a patient had these four factors, non-PV was detected with 96.8% specificity.

Conclusion

Female sex, lower BMI, absence of hypertension, and higher E/e’ were significant indicators of non-PV foci in patients with paroxysmal AF. Reviewing these factors in advance may be useful for selecting a device to perform pulmonary vein isolation.

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Authors and Affiliations

  1. Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama-shi, Saitama, 330-8553, Japan

    Keita Watanabe, Junichi Nitta, Osamu Inaba, Akira Sato, Yukihiro Inamura, Nobutaka Kato & Masahito Suzuki

  2. Department of Cardiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Keita Watanabe, Masahiko Goya, Kenzo Hirao & Tetsuo Sasano

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  1. Keita Watanabe
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Correspondence to Keita Watanabe.

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Watanabe, K., Nitta, J., Inaba, O. et al. Predictors of non-pulmonary vein foci in paroxysmal atrial fibrillation. J Interv Card Electrophysiol 61, 71–78 (2021). https://doi.org/10.1007/s10840-020-00779-x

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  • DOI: https://doi.org/10.1007/s10840-020-00779-x

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