Distribution Patterns of Paroxysmal Atrial Fibrillation Triggers and Catheter Ablation Success Rates

Objective

Investigate the distribution of triggers in paroxysmal atrial fibrillation (PAF) patients and assess the efficacy of circumferential pulmonary vein isolationI (CPVI) combined with non-pulmonary veins (PV) trigger ablation over 1 year.

Methods

This prospective study included 130 PAF patients undergoing initial catheter ablation. A standardized protocol was applied before CPVI, followed by ablation targeting non-PV triggers. Ablation success was marked by the inability to induce atrial fibrillation (AF) or related arrhythmias. Patients underwent Holter monitoring at intervals post-surgery, culminating in a 7-day exam at 12 months.

Results

Atrial fibrillation (AF) was induced in 88 patients (67.0%), with 94 foci identified. The left pulmonary vein was a common source, but the superior vena cava emerged as the most prevalent non-PV site. The 1-year success rate was 86.0%, with no significant differences in success rates among trigger types. However, non-PV triggers were linked to lower recurrence rates post-surgery (HR 0.27, 95% CI 0.08–0.96, p = 0.04).

Conclusion

The study found that the combination of drug stimulation and high-frequency atrial stimulation before CPVI significantly boosted AF induction rates and revealed a high incidence of non-PV triggers. Effective intraoperative induction and accurate identification of non-PV triggers, particularly in the superior vein cava (SVC), contributed to a substantial reduction in postoperative recurrence rates. This approach suggests a potential strategy for improving outcomes in PAF treatment.