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32. Cardiovascular Nursing
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Non-Pulmonary Vein Triggers – Maximizing Success in Atrial Fibrillation Redo Procedures
Session:
SESSÃO DE POSTERS 41 - ABLAÇÃO DE FIBRILHAÇÃO AURICULAR
Speaker:
Francisco Salvaterra
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Francisco Salvaterra; Ana Abrantes; Joana Brito; Daniel Inácio Cazeiro; Miguel Azaredo Raposo; Afonso Nunes Ferreira; Gustavo Lima da Silva; João Ribeiro; Luís Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><strong>Introduction: </strong>In atrial fibrillation (AF), non-pulmonary vein (non-PV) triggers are a potential cause of arrhythmic relapse after pulmonary vein isolation (PVI). Their<br /> relevance in clinical practice remains controversial, with some studies suggesting their presence in most patients (pts), while others report them in a small minority.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><strong>Purpose: </strong>To characterize non-PV triggers and evaluate the efficacy of their targeted ablation in patients undergoing AF redo ablation.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><strong>Methods: </strong>This retrospective single-center study included patients who underwent AF redo ablation between 2015 and 2024. Mapping was performed using high-density<br /> electroanatomic catheters. Non-PV triggers were systematically mapped whenever repetitive spontaneous ectopic beats were identified during map collection. Additionally, in redo procedures where PVs were completely isolated, non-PV trigger inducibility was tested with isoprenaline infusion and programmed atrial stimulation.<br /> Non-PV trigger ablation targeted the earliest atrial activation signal. At the end of the procedure, non-PV trigger induction was re-evaluated with isoprenaline infusion and<br /> programmed atrial stimulation.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><strong>Results:</strong> A total of 264 pts underwent redo AF ablation. Non-PV triggers were identified in 12 pts (mean age 62.5 years; 83% male). Most non-PV triggers (75%) were<br /> in the left atrium, primarily on the anterior and posterior walls. In the right atrium, non-PV triggers were identified in the superior cavoatrial junction (2 cases) and the coronary sinus ostium (1 case). Low-voltage areas consistent with previous PVI were identified in all pts, with reconduction or residual electrograms in ≥1 vein in 83% of<br /> them. Additional low-voltage areas outside PVs were documented in one patient. After ablation of the triggers, no atrial arrhythmias were inducible. During a median follow-up of 3.9 years, AF recurrence occurred in 44% of pts, comparable to the pts who underwent redo AF ablation without non-PV triggers (~50%).</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><strong>Conclusion: </strong>Non-PV triggers were relatively uncommon in pts with recurrent AF after ablation. Nevertheless, prompt identification and ablation of these triggers were crucial for restoring sinus rhythm.</p>
Slides
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