Clinical Characteristics And The Mechanism Of The Non-Pulmonary Vein Foci Ablation In Patients With Paroxysmal Atrial Fibrillation

Objective: To discuss the mechainsim,characteristics and effects of the ablations of the non-pulmonary vein foci paroxysmal atrial fibrillation.Methods: 151 patients of paroxysmal atrial fibrillation in First Affilated Hospital Of Soochow Universty between 2010.1 and 2014.4 were included in the study. Among them there were 89 males.The average age was 24-73(60.97± 8.58) years old. Average atrial fibrillation duration was 41.85 ± 26.31 months. Circumferential pulmonary vein antrum isolation guided bya 3-D mapping system was performed.ditional ablation was performed if other trigger loci were found or other sustained tachycardias could beinduced.According the results of the ablation, patients were divided into 2 group:the pulmonary trigger and the non-pulmonary trigger.After ablation patients were followed up for the first/third/sixth/ twelfth months with routine electrocardiogram(ECG), 24 hours electrocardiogram and echocardiography.After that, every half a year had a review. If the patients had symptoms of palpitation during follow-up, we recorded the ECG at any time. According to thfollow-up results, patients were divided into 2 groups: group A(success group)and group B(recurrence group).Patients in group A didn’t has episodes of AF, atrial flutter or atrial tachycardia without using anti-arrhythmic drugs or using preoperative ineffective anti-arrhythmic drugs during 3 months after ablation,and AF episodesload was significantly reduced. Patients in group B had recurrence of AF, atrial flutter or atrialtachycardia, and the duration was greater than or equal to 30 seconds.Results: non—PV triggers were observed in 26 patients(group l I),20 were originated from superior vena cava.3 were located in the roof of left atrium,1 were located in auricula sinistra,1 were located in cristaterminalis,1 were located in the top of atrial septal.After the first ablation,the recurrence of group1 was higher than group 2.Between the two group,serious vagal reflex(1 case), right lower limb deep venous thrombosis(1 case)and femoral artery-vein fistula(1 case).Conclusions:1. Pulmonary vein is the most common reason of paroxysmal atrial fibrillation,non-pulmonary is also one of the reason for paroxysmal atrial fibrillation;2.the non-pulmonary vein foci included the superior vena cava, coronary sinus, crista,etc.3. The recurrence rate of patients who received other site isolation after pulmonary vein isolation was reduced compared with patients who received pulmonary veins isolation only.