Targeting supraventricular ectopic complexes: Which approach should be used and how does it affect atrial fibrillation?  Jordi Heijman, Dobromir Dobrev, Harry J.G.M. Crijns  International Journal of Cardiology  Volume 244, Pages 202-203 (October 2017) DOI: 10.1016/j.ijcard.2017.06.013 Copyright © 2017 Elsevier B.V. Terms and Conditions

Fig. 1 Role of the suppression of supraventricular ectopic complexes (SVECs) by antiarrhythmic drugs (AADs) and catheter ablation in atrial fibrillation (AF) management. SVECs can initiate AF in a vulnerable substrate developing as part of an atrial myopathy in response to a wide range of risk factors. Alhede et al. [5] show that SVEC burden is associated with AF burden and that AADs suppress SVEC more effectively than catheter ablation. Nonetheless, ablation is generally more effective in preventing AF recurrence than AAD therapy. One potential explanation for this is that not all SVECs are equal. AADs may be better at suppressing the more common ‘benign’ (i.e., non AF-inducing) SVECs, whereas although catheter ablation affects fewer SVECs, they may preferentially block the ‘malignant’ AF-inducing SVECs. The characteristics (location, timing, etc.) that determine whether an SVEC is benign or malignant require further investigation in subsequent studies. International Journal of Cardiology 2017 244, 202-203DOI: (10.1016/j.ijcard.2017.06.013) Copyright © 2017 Elsevier B.V. Terms and Conditions