\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{Clinical Impact of Eliminating Non-Pulmonary Vein Triggers in Patients
with Persistent Atrial Fibrillation: Highlights on Non-Pulmonary Vein
Foci and Premature Atrial Contraction}



\author[1]{Shota Tohoku}%
\author[1]{Masato Fukunaga}%
\author[1]{Michio  Nagashima}%
\author[1]{Jun Hirokami}%
\author[1]{Kengo Korai}%
\author[1]{Kei Yamamoto}%
\author[1]{Harushi Niu}%
\author[1]{Ayaka Takeo}%
\author[1]{Kenji Ando}%
\author[1]{Kenichi Hiroshima}%
\affil[1]{Kokura Memorial Hospital}%


\vspace{-1em}



  
  \date{May 24, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Backgrounds: The role of non-pulmonary vein (PV) triggers ablation in
persistent atrial fibrillation (PEAF) was suggested but it is still
under debate. Objectives: We aimed to assess the effectiveness of non-PV
trigger targeted ablation for patients with PEAF. Methods: Consecutive
patients with PEAF undergoing catheter ablation (CA) between January
2015 and April 2017 were enrolled. Isoproterenol plus adenosine
challenge was performed to provoke non-PV triggers. Non-PV triggers were
defined as the non-PV foci inducing AF and/or frequent premature
contraction (non-PV PAC) from other than PVs. Three groups were defined:
group 1 (n=186) without non-PV triggers; group 2 (n=65) with non-PV
triggers that could be completely eliminated with CA; group 3 (n=49)
with non-PV triggers still inducible after CA. Primary endpoint was
freedom from any atrial tachyarrhythmia (ATa) recurrence. Results: A
total of 300 patients (230 males, age 64\selectlanguage{ngerman}±10) were enrolled. Mean
follow-up period was 27±10 months. Freedom from ATa recurrence at 1- and
2 years were significantly lower in group 3 compared to the other 2
groups (group 1; 74.7\%, 67.2\% vs. group 2; 75.8\%, 68.3\% vs. group 3:
52.1\%, 38.6\%, P=0.0005), irrespective of the type of non-PV triggers
(non-PV PAC vs. non-PV foci initiating AF). On multivariate analysis,
unsuccessful elimination of non-PV trigger was an independent predictor
for ATa recurrence (HR 1.80 {[}95\%CI:1.07-2.93{]}, P=0.026).
Conclusions: Successful non-PV trigger elimination can improve the ATa
recurrence rate in PEAF ablation. ATa recurrence rate is higher, if
non-PV foci or even non-PV PAC remains in patients with PEAF.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy




\selectlanguage{english}
\FloatBarrier
\end{document}

