EP Expert Doctors-Team Tsuchiya, Koto 3-14-28, Kumamoto 862-0909, Japan.
Europace. 2010 Dec;12(12):1698-706. doi: 10.1093/europace/euq326.
Non-pulmonary vein (PV) foci are sometimes difficult to identify and eliminate. The EnSite array (EA) reveals the detailed beat-to-beat virtual activation. This study aimed to characterize non-PV foci using the EA.
Sixty-five patients with paroxysmal atrial fibrillation (AF) were included. All had ectopy initiating AF and/or focal atrial tachycardia analysed using the EA. All patients underwent PV isolation (PVI) and additional ablation of non-PV foci if present. The EA revealed 59 PV foci in 48 patients (Group P) and 19 non-PV foci in 17 patients (Group N). In Group N, 12 patients (71%) also had 17 PV foci. The non-PV foci were frequently distributed in the left atrial (LA) roof (n = 5) and superior vena cava (n = 5). Pulmonary vein isolation during on-going AF terminated AF in 34 of 37 in Group P (92%) and 4 of 14 in Group N (29%) patients (P < 0.0001). All non-PV foci were eliminated by an EA-guided ablation. During a 23 ± 10 month follow-up, 11 patients (17%) had AF recurrences, mainly due to LA-PV reconnection.
Non-PV foci are prevalent in the LA roof and SVC sites, but can originate from other sites as well. When non-PV foci are observed, PVI may be insufficient and should be supplemented with non-PV foci ablation.
非肺静脉（PV）病灶有时难以识别和消除。EnSite 数组（EA）可显示详细的逐搏虚拟激活。本研究旨在使用 EA 来描述非 PV 病灶。
共纳入 65 例阵发性心房颤动（AF）患者。所有患者均通过 EA 分析起源于异位灶的 AF 和/或局灶性房性心动过速。所有患者均行 PV 隔离（PVI），若存在非 PV 病灶则行额外消融。EA 在 48 例患者中发现 59 个 PV 病灶（组 P）和 17 例患者中的 19 个非 PV 病灶（组 N）。在组 N 中，12 例（71%）患者还存在 17 个 PV 病灶。非 PV 病灶多分布于左房（LA）房顶（n=5）和上腔静脉（n=5）。在持续 AF 期间行 PVI 可终止 37 例组 P 患者中的 34 例（92%）和 14 例组 N 患者中的 4 例（29%）的 AF（P<0.0001）。所有非 PV 病灶均通过 EA 引导的消融消除。在 23±10 个月的随访期间，11 例（17%）患者出现 AF 复发，主要与 LA-PV 再连接有关。
非 PV 病灶多位于 LA 房顶和 SVC 部位，但也可能源自其他部位。当观察到非 PV 病灶时，PVI 可能不足，应补充非 PV 病灶消融。
