Percutaneous Treatment Of Non-Paroxysmal Atrial Fibrillation

Percutaneous Treatment Of Non-Paroxysmal Atrial Fibrillation: A Paradigm Shift From Pulmonary Vein To Non-Pulmonary Vein Trigger Ablation?

Arrhythmia & Electrophysiology Review 2018;7(4):256–60.


Pulmonary vein antrum isolation is the most effective rhythm control strategy in patients with paroxysmal AF. However, catheter ablation of non-paroxysmal AF has a lower success rate, even when persistent isolation of pulmonary veins (PVs) is achieved. As a result of arrhythmia-related electophysiological and structural changes in the atria, sites other than the PVs can harbour triggers. These non-PV triggers contribute to AF relapse. In this article, we summarise the rationale and current evidence supporting the arrhythmogenic role of non-PV triggers and our ablation approach to patients with non-paroxysmal AF.

Domenico G Della Rocca

Sanghamitra Mohanty

Chintan Trivedi

Luigi Di Biase

Andrea Natale


Although PVAI is the mainstay of each AF ablation, mounting evidence has demonstrated a pivotal role of non-PV triggers in early and late atrial tachyarrhythmia relapse and progression.

Patients with non-paroxysmal AF display a higher prevalence of triggers from sites other than the PVs and targeting these arrhythmogenic foci is of utmost importance to achieve better long-term outcomes. Their localisation can be easily achieved by means of multi-electrode catheters positioned in specific areas of the right and left atrium during the pharmacological challenge test. Moreover, empirical non-PV trigger ablation may further improve long-term freedom from atrial arrhythmias in selected cohorts of AF patients.

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