{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T01:42:10Z","timestamp":1789350130756,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation; however, recurrences often originate from non\u2010pulmonary vein (non\u2010PV) foci. The Complex Signal Identification (CSI) algorithm in CARTO 3 assigns electrogram\u2010fractionation scores (0\u201310). This study evaluated the feasibility of CSI\u2010assisted mapping for identifying non\u2010PV triggers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 23 consecutive patients undergoing first\u2010time AF ablation between January and June 2024. After PVI, non\u2010PV triggers were induced using isoproterenol and adenosine triphosphate (ATP). When ectopy was absent, rapid pacing during isoproterenol infusion followed by defibrillation was performed, and ATP testing was repeated. High\u2010density CSI mapping was conducted during sinus rhythm or high right atrial pacing using system default settings, targeting atrial components after ventricular blanking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 33 non\u2010PV foci were localized (20 left atrium [LA], 13 right atrium [RA]). The mean CSI scores of LA and RA foci were 9.0\u2009\u00b1\u20092.3 and 8.8\u2009\u00b1\u20092.7, respectively. ROC analysis showed an AUC of 0.917 for discriminating non\u2010PV foci, with an optimal cutoff of 8.5 (sensitivity 87.9%, specificity 88.3%). At 12\u2009months, arrhythmia\u2010free survival was 82.4% under symptom\u2010driven follow\u2010up. Ablation was selectively performed at the earliest activation and adjacent high\u2010CSI points, avoiding indiscriminate lesion delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CSI\u2010assisted mapping provided practical, adjunctive guidance to provocation and activation mapping for non\u2010PV focus localization. While apparent discrimination was promising, the 8.5 threshold remains exploratory. Larger multicenter studies with standardized CSI settings and systematic post\u2010ablation assessment are warranted to validate these preliminary findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/joa3.70230","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T06:35:42Z","timestamp":1764225342000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Relationship Between Complex Signal Identification and Non\u2010Pulmonary Vein Foci"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2559-4745","authenticated-orcid":false,"given":"Hiroyuki","family":"Kono","sequence":"first","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Hiroshima","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1155-0190","authenticated-orcid":false,"given":"Keigo","family":"Misonou","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5569-972X","authenticated-orcid":false,"given":"Koumei","family":"Onuki","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiko","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5588-0533","authenticated-orcid":false,"given":"Jun","family":"Hirokami","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomonori","family":"Katsuki","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rei","family":"Kuji","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kengo","family":"Korai","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0230-4556","authenticated-orcid":false,"given":"Masato","family":"Fukunaga","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michio","family":"Nagashima","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kokura Memorial Hospital  Kitakyushu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408288"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2019.03.006"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.11.025"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.03.105"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.05.037"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.06.028"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.14830"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euab004"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.119.008667"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16047"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/joa3.13222"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.01.012"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12194"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2015.01.004"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.10.012"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.124.013351"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.14605"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd9120249"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaa332"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/joa3.70179"}],"container-title":["Journal 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