Objective: To explore the reason for atrial ifbrillation (AF) recurrence in patients with or without pulmonary vein (PV) triggers during primary circumferential PV atrium isolation. Methods: A total of 181 patients with paroxysmal AF were enrolled including 135 male with the mean age of (55.0±11.4) years and mean medical history of (64.6±68.5) months. Circumferential PV atrium isolation was performed under the guidance of 3-D mapping system. Post-operative conventional programmed stimulation was performed and additional ablation was conducted at the same time if the patients combining supraventricular arrhythmia or non-PA triggers. According to operation records, the patients were divided into 2 groups: PV incurred AF group,n=61 and Non-PV incurred AF group, n=120. All patients received ECG, dynamic ECG before discharge and they were followed-up at (1-3) months and 6 months after operation. The patients with AF recurrence would receive the second ablation. Results: All patients had successful PV isolation. In Non-PV incurred AF group, 12 patients had clear non-PV triggers, 1 located at the roof of left atrium and 11 originated from superior vena cava. Clinical information was similar between 2 groups. During (36.1±16.4) months follow-up period, AF recurrence rates were similar between 2 groups (22.9% vs 33.3%), P=0.15. During 2nd ablation, in Non-PV incurred AF group, 12 patients received re-PV isolation and superior vena cava trigger was found in 1 patient; in PV incurred AF group, 36 patients received re-PV isolation and 17 triggers were found in 16 patients including 2 originated from PV and 15 at outside of PV as 12 originated from superior vena cava, 2 from coronary sinus and 1 from septum. There were 15 patients with AF recurrence after the 2nd ablation and 2 of the received 3rd procedure, the triggers located at left atrial septum and coronary sinus respectively; 1 patient received 4th ablation and the trigger located at the rear wall of left atrium. After 2nd ablation, the success rate in PV incurred AF group was higher than Non-PV incurred AF group (95.1% vs 84.1%),P=0.03; while the ratio of non-PV triggers was lower in PV incurred AF group (1.98% vs 22.5%),P<0.001. Conclusion: In patients with clear PV triggers, the major cause of AF recurrence was the recovered conduction from LA to PV; in patients without clear PV triggers, the major cause of AF recurrence was non-PV triggers and they usually need additional ablation.%目的：探讨阵发性心房颤动（房颤）患者肺静脉前庭首次消融术中有或无肺静脉触发灶的复发原因。 方法：共入选181例阵发性房颤患者，男性135例，女性46例，平均年龄（55.0±11.4）岁，平均病史为（64.6±68.5）个月。在三维标测系统指导下行肺静脉前庭隔离术达到肺静脉-左心房电学隔离；术后常规程序刺激诱发，若合并室上性心律失常或者非肺静脉触发灶，同时消融。根据术中记录到肺静脉电位翻转并触发房颤为肺静脉触发房颤组（61例），无明确肺静脉触发房颤为无肺静脉触发房颤组（120例）。出院前所有患者均做常规体表心电图和动态心电图检查，术后1~3个月，6个月分别再行上述随访检查。所有复发患者均接受二次消融。 结果：所有患者术中均成功隔离肺静脉，但无肺静脉触发房颤组中明确有12例为非肺静脉触发灶，1例位于左心房顶部，11例起源于上腔静脉。两组间的临床资料比较差异无统计学意义。平均随访（36.1±16.4）个月，首次消融术后，与无肺静脉触发房颤组相比，肺静脉触发房颤组复发房颤率差异无统计学意义（22.9% vs 33.3%，P=0.15）。二次手术中，无肺静脉触发房颤组中12例患者均再次隔离肺静脉，其中1例术中发现同时存在上腔静脉触发灶。肺静脉触发房颤组中，36例接受再次隔离，静脉点滴异丙肾上腺素及“弹丸式”注射三磷酸腺苷时，16例患者共诱导出17处房颤触发灶，2例起源于肺静脉，15例为肺静脉之外（其中12例为上腔静脉起源，2例起源于冠状静脉窦，间隔处起源1例）。二次术后仍有15例复发，其中2例接受三次手术，触发灶分别位于左心房间隔与冠状静脉窦，1例患者四次手术，触发灶位于左心房后壁。二次消融术后，肺静脉触发房颤组的成功率明显高于无肺静脉触发房颤组（95.1% vs 84.1%，P=0.03）。但肺静脉触发房颤组的非肺静脉触发灶的比例明显低于无肺静脉触发房颤组，两组比较差异有统计学意义（1.98% vs 22.5%，P<0.001）。 结论：明确肺静脉触发灶者，复发的主要原因是左心房肺静脉传导的恢复。无明确肺静脉触发者，主要原因是非肺静脉触发灶，常需要额外的消融。
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