Gold Cards & Hidden Triggers: A New Look at Afib | JACC Baran

Hosts Mitsuaki Sawano, MD, and Regional Associate Editor Nobuhiro Ikemura, MD, welcome Takashi Ikenouchi, MD, a physician scientist at the Cedars-Sinai Medical Center, Smidt Heart Institute, to discuss the headline-grabbing “Gold Card” sale and a novel approach to atrial fibrillation: an embryological classification of arrhythmogenic triggers. While pulmonary vein isolation (PVI) remains the cornerstone of AF ablation, up to 30% of triggers originate outside the pulmonary veins, contributing to recurrence and suboptimal outcomes. As PVI outcomes begin to plateau, this embryology-informed framework—categorizing triggers into common pulmonary vein, sinus venosus, and primitive atrium origins—offers a path toward more personalized and precise AF therapies.