Longer Period of Atrial Fibrillation Persistence Was Associated with Higher Prevalence of Non-Pulmonary Vein Triggers

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Background: We assessed the possibility that the progression of atrial fibrillation (AF) triggers was one of the reasons for high recurrence rate after catheter ablation (CA) for AF in patients with long-persisting AF (LLAF). Method: Consecutive 263 patients who underwent CA to AF persisting >1 week were divided into LLAF-group (persisted>1 year, n=131) and PeAF-group (others, n=132). We performed electrical cardioversion before procedure to determine the presence or absence of AF-Trigger, define as ectopies initiating recurrence within 90 seconds after restoration of sinus rhythm (SR) reproducibly, and to distinguish AF-triggers from pulmonary vein (PV-AF-Triggers) and those from non-pulmonary vein (Non-PV-AF-Triggers). We performed average 1.3 +⁄− 0.5 sessions of CA, followed them for 20 +⁄− 11 months. Result: The prevalence of AF-triggers was almost same between the groups (LLAF-group vs. PeAF-group, 27% vs. 27%, p=0.97), but the prevalence of Non-PV-AF-Triggers was significantly higher in LLAF-group (13% vs. 4%, p=0.0019). Successful AF-Triggers ablation was highly associated with successful SR maintenance (OR=16.3, p<0.0001). But the success rate of AF-Trigger ablation was significantly lower than in patients with Non-PV-AF-Triggers than in those with PV-AF-Triggers (30% vs. 100%, p<0.0001). Conclusion: The higher prevalence of Non-PV AF-triggers was one of the reasons for the high AF recurrence rate after CA in LLAF patients.