The Case Series of Atrial Fibrillation Originating from Non-Pulmonary Vein and Non-Thoracic Vein

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Background: Pulmonary veins (PVs), extrapulmonary thoracic veins (TVs), and atrial appendage are recognized as a source of a trigger and a driver of atrial fibrillation (AF). But other sites of initiation of AF are not well known. We report the AF cases originating from non-PVs, non-TVs, and non-appendage. Methods and Results: Four-hundred and fifty-three consecutive patients (94% paroxysmal) undergoing radiofrequency catheter ablation (RFCA) for symptomatic AF were studied. 5 patients (4 males, age 16–73, follow-up duration is 6–28 months) showed no firings from PVs, TVs and appendage in electrophysiological study. The initiation sites of AF are posterior atrial septum in 2 patients, adjacent area of His bundle in 1 patient, left atrial postero-inferior wall in 1 patient, and lateral wall of right atrium in 1 patient. All of the patients showed only an incessant and short time lasting AF that sustained within 30 seconds. And they all were cured AF by RFCA of these areas without PV isolation and ablation of TVs and appendage. Conclusions: In 5 of 453 patients (1.1%), the initiator of AF is the area of atrium out of PVs, TVs and appendage. All these patients showed that AF was incessant and short lasting.