부산대학교 도서관

Introduction: Therapeutic strategy for non-pulmonary vein (PV) triggers of atrial fibrillation (AF) has not been well established although they are the major cause of AF recurrence after PV isolation. The atrial postero-septum or right atrial crista terminalis (CT) are the common non-pulmonary vein (PV) trigger sites of atrial fibrillation (AF). For them, a focal ablation is often insufficient due to a regional arrhythmogenicity. We devised an original linear ablation method, named 'Icho Line” covering the non-PV triggers from this area.Methods: Eight hundred and thirty-two AF ablation patients were retrospectively studied. An AF induction test was conducted after each PV isolation procedure. Non-PV triggers were detected in 104 patients (12.7%), among which Icho line ablation was performed in 39 patients (37.5%) with documented triggers of AF from postero-septum or CT. A linear ablation was designed horizontally from the anterior right PV isolation line to fossa ovalis in the left atrium. In the right atrium, the opposite side of the left atrial ablation was continuously ablated toward the CT like the shape of a ginkgo leaf (Figure).Results: Atrial tachyarrhythmia recurrence free rate in the Icho line group and other non-PV ablation patients were 61.8% and 45.4%, respectively (P=0.54, Figure). Recurrence with atrial tachycardia was very rare in the Icho line group.Conclusions: A novel designed Icho line is a feasible and effective ablation strategy covering non-PV triggers from the atrial septum and CT.