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Background It has been reported that elimination of non-pulmonary vein (PV) triggers after PV isolation is a good predictor of atrial tachyarrhythmia free survival. However, precise mapping of triggers outside from superior vena cava (SVC) or left atrial posterior wall (LAPW) are difficult. The aim of this study is to assess the efficacy of self-reference mapping technique to eliminate non-PV triggers originated from outside of primordial pulmonary vein area. Methods Total of 431 patients (446 procedures) underwent atrial fibrillation (AF) ablation in a hospital and in a medical center from January 2017 to March 2019. After isolation of PV, non-PV triggers were induced with isoproterenol and/or adenosine triphosphate. Reproducible non-PV triggers were targeted to ablate using following self-reference mapping technique: A trigger conducts centrifugally and the earliest site should be distinguished from other later activated sites. Using a PentaRay multipolar catheter, the operators annotated the earliest site of local activation and a reference tag was placed. The multipolar catheter was then moved to the reference tag and the process repeated. Ultimately, we identified clusters of early circumferential activation and ablated. Results A total of 32 non-PV triggers excluding the origin from LAPW and SVC were induced in 23 patients. Nineteen triggers (59%) were located in the right atrium and 13 triggers (41%) in the left atrium (Figure 1). All triggers were eliminated with ablation and AF was non-inducible in all patients at the end of the procedure. During the follow-up (529±270 days), 18 patients (77%) were free from atrial tachyarrhythmias after a 3-month blanking period. Three patients received additional ablation procedures for recurrent atrial arrhythmias. No non-PV triggers ablated during the previous procedure were observed. Conclusion A novel self-reference mapping technique is useful for eliminating non-PV triggers in terms of the short- and long-term success. Figure 1. Distribution of non-PV triggers Funding Acknowledgement Type of funding source: None

european heart journal

Multicenter study of novel mapping technique to detect non-pulmonary vein triggers excluding the origin from left atrial posterior wall and superior vena cava