{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:39:10Z","timestamp":1790912350669,"version":"4.1.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2021,8,21]],"date-time":"2021-08-21T00:00:00Z","timestamp":1629504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and Results<\/jats:title>\n                  <jats:p>A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW. A standardized protocol was performed to confirm persistent PVAI and elicit any triggers originating from non-PV sites. All non-PV triggers initiating sustained atrial tachyarrhythmias were ablated. Ablation of non-PV sites triggering non-sustained runs (&amp;lt;30\u2009s) of atrial tachyarrhythmias or promoting frequent premature atrial complexes (\u226510\/min) was left to operator\u2019s discretion. Overall, 1319 (73.2%) patients had documented triggers from non-PV areas. After 17.4\u2009\u00b1\u20098.5\u2009months of follow-up, the cumulative freedom from atrial tachyarrhythmias among patients without inducible non-PV triggers (n\u2009=\u2009484) was 70.2%. Patients with ablation of induced non-PV triggers had a significantly higher arrhythmia control than those whose triggers were not ablated (67.9% vs. 39.4%, respectively; P\u2009&amp;lt;\u20090.001). After adjusting for clinically relevant variables, patients in whom non-PV triggers were documented but not ablated had an increased risk of arrhythmia relapse (hazard ratio: 2.39; 95% confidence interval: 2.01\u20132.83; P\u2009&amp;lt;\u20090.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Pulmonary vein antrum isolation extended to the entire PW might provide acceptable long-term arrhythmia-free survival in PerAF patients without inducible non-PV triggers. In our population of PerAF patients, non-PV triggers could be elicited in \u223c70% of PerAF patients and their elimination significantly improved outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euab161","type":"journal-article","created":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T19:11:57Z","timestamp":1623697917000},"page":"1939-1949","source":"Crossref","is-referenced-by-count":76,"title":["Targeting non-pulmonary vein triggers in persistent atrial fibrillation: results from a prospective, multicentre, observational registry"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3837-3462","authenticated-orcid":false,"given":"Domenico G","family":"Della Rocca","sequence":"first","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Di Biase","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"},{"name":"Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA"},{"name":"Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA"},{"name":"Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA"},{"name":"Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanghamitra","family":"Mohanty","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chintan","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carola","family":"Gianni","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Romero","sequence":"additional","affiliation":[{"name":"Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Tarantino","sequence":"additional","affiliation":[{"name":"Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Magnocavallo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Bassiouny","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica N","family":"Natale","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel Quintero","family":"Mayedo","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Lavalle","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghulam","family":"Murtaza","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, Kansas University Hospital, Kansas City, KS, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Akella","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, Kansas University Hospital, Kansas City, KS, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni B","family":"Forleo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Luigi Sacco Hospital, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Al-Ahmad","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. 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IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney P","family":"Horton","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan F","family":"Viles-Gonzalez","sequence":"additional","affiliation":[{"name":"Miami Cardiovascular Institute, Baptist Health, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhanunjaya","family":"Lakkireddy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Luigi Sacco Hospital, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Natale","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. 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