Do we need assessment of nonpulmonary vein triggers for successful ablation of atrial fibrillation?

Targeting of nonpulmonary vein (NPV) arrhythmogenic sites that are responsible for triggering and perpetuating atrial fibrillation (AF) is an essential part of catheter ablation for persistent AF. It also has the potential to increase the success rate of ablation in the case of paroxysmal AF. The study by Chang et al. provides detailed data on the prevalence of NPV triggers in a large cohort of patients undergoing radiofrequency catheter ablation for AF. The presence of NPV triggers was strongly and independently associated with a higher AF recurrence rate, despite being targeted at index procedure. Controversies in the optimum strategy of ablation for persistent AF are discussed. New sophisticated methods for focal impulse and rotor mapping are mentioned that will hopefully assist in more efficient AF ablation procedures by facilitating the assessment and selective targeting of arrhythmogenic substrates, especially in the case of persistent AF.