Electrophysiologic and Clinical Consequences of Left Atrial Anterior Wall Linear Ablation in Patients With Persistent Atrial Fibrillation

2015 ◽  
Vol 26 (9) ◽  
pp. 934-943 ◽  
Author(s):  
JINLIN ZHANG ◽  
CHENG TANG ◽  
YONGHUA ZHANG ◽  
XI SU
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Anterior Wall ◽  
Linear Ablation ◽  
Clinical Consequences

scholarly journals Long-term outcomes of empirical extra-pulmonary vein linear ablation in patients with persistent atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Hwang ◽  
M Kim ◽  
H Yu ◽  
T Kim ◽  
J Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Clinical Recurrence ◽  
Linear Ablation ◽  
Extra Pulmonary

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants [HI18C0070] and [HI19C0114] from the Korea Health 21 R&D Project, Ministry of Health and Welfare, and a grant [NRF-2020R1A2B01001695] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF). Background Although extra-pulmonary vein (PV) left atrial (LA) linear ablation has been performed during catheter ablation (CA) of persistent atrial fibrillation (PeAF), the long-term efficacy and safety of this procedure have not yet been verified. Purpose We investigated whether an anterior line (AL) and posterior box ablation (POBA) in addition to circumferential PV isolation (CPVI) improves the rhythm without worsening the LA function in PeAF patients. Methods We retrospectively compared the additional AL + POBA and CPVI alone groups in 604 patients with PeAF who underwent regular rhythm follow-ups (16.9%; males 79.3%, 58.5 ± 10.7 years of age) after propensity score matching. The primary endpoint was AF recurrence after single procedures and secondary endpoints were the cardioversion rate, response to anti arrhythmic drugs, LA changes, and re-conduction rates of the de-novo ablation lesion set. Results After a mean follow-up of 45.2 ± 33.6 months, the clinical recurrence rate did not significantly differ between the two groups (log-rank p = 0.554) despite longer procedure times in the AL + POBA group (p < 0.001). Atrial tachycardia recurrences (p = 0.001) and the cardioversion rates after ablation (p < 0.001) were higher in the AL + POBA group than CPVI group. AL + POBA was associated with better rhythm outcomes in patients with large anterior LA volume indices (p for interaction 0.037) and low mean LAA(left atrial appendage) voltages (p for interaction 0.019). In repeat procedures, the LA pulse pressure elevation was significant after the AL + POBA. Conclusion In patients with PeAF, an AL + POBA in addition to the CPVI did not improve the rhythm outcomes nor influence the long-term safety, and lead to more extended procedures. Procedure outcomes OverallAL + POBACPVIp-value(n = 604)(n = 302)(n = 302)Procedure time, min190.8 ± 62.6226.9 ± 49.4154.6 ± 52.8<0.001Ablation time, sec5079 ± 19566420 ± 13723738± 1475<0.001Overall complications24 (4.0)13 (4.3)11 (3.6)0.835Early recurrence, n (%)277 (45.9)129 (42.7)148 (49.0)0.142Recurrence type AT, n (% in early recur)77 (27.8)51 (39.5)26 (17.6)<0.001Clinical recurrence within 1-year, n(%)116 (19.2)52 (17.2)65 (21.5)0.256Recurrence type AT, n (% in clinical recur)60 (23.1)46 (30.7)14 (12.7)0.001Cardioversion, n (% in total recur/ % overall)105 (40.4/17.4)74 (49.3/24.5)31 (28.1/10.3)<0.001POBA, posterior box ablation; AL, anterior line; CPVI, circumferential pulmonary vein isolation; AT, atrial tachycardia;Abstract Figure. Long term ablation outcome

Results of a new left atrial linear ablation approach compared to antral pulmonary vein isolation for cure of persistent atrial fibrillation

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S191-S192
Author(s):  
Douglas Gibson ◽  
Uma Srivatsa ◽  
Bobbi Hoppe ◽  
Dan Muhtar ◽  
Navinder Sawhney ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
New Left ◽  
Persistent Atrial Fibrillation ◽  
Linear Ablation

scholarly journals Optimum lesion set and predictors of outcome in persistent atrial fibrillation ablation: a meta-regression analysis

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1176-1184 ◽  
Author(s):  
Arunashis Sau ◽  
Sayed Al-Aidarous ◽  
James Howard ◽  
Joseph Shalhoub ◽  
Afzal Sohaib ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Success Rates ◽  
Factors Affecting ◽  
Improved Outcomes ◽  
Linear Ablation ◽  
Meta Regression ◽  
Meta Regression Analysis

Abstract Aims Ablation of persistent atrial fibrillation (PsAF) has been performed by many techniques with varying success rates. This may be due to ablation techniques, patient demographics, comorbidities, and trial design. We conducted a meta-regression of studies of PsAF ablation to elucidate the factors affecting atrial fibrillation (AF) recurrence. Methods and results  Databases were searched for prospective studies of PsAF ablation. A meta-regression was performed. Fifty-eight studies (6767 patients) were included. Complex fractionated atrial electrogram (CFAE) ablation reduced freedom from AF by 8.9% [95% confidence interval (CI) −15 to −2.3, P = 0.009). Left atrial appendage [LAA isolation (three study arms)] increased freedom from AF by 39.5% (95% CI 9.1–78.4, P = 0.008). Posterior wall isolation (PWI) (eight study arms) increased freedom from AF by 19.4% (95% CI 3.3–38.1, P = 0.017). Linear ablation or ganglionated plexi ablation resulted in no significant effect on freedom from AF. More extensive ablation increased intraprocedural AF termination; however, intraprocedural AF termination was not associated with improved outcomes. Increased left atrial diameter was associated with a reduction in freedom from AF by 4% (95% CI −6.8% to −1.1%, P = 0.007) for every 1 mm increase in diameter. Conclusion  Linear ablation, PWI, and CFAE ablation improves intraprocedural AF termination, but such termination does not predict better long-term outcomes. Study arms including PWI or LAA isolation in the lesion set were associated with improved outcomes in terms of freedom from AF; however, further randomized trials are required before these can be routinely recommended. Left atrial size is the most important marker of AF chronicity influencing outcomes.

scholarly journals Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

2021 ◽  
Vol 10 (14) ◽  
pp. 3129
Author(s):  
Riyaz A. Kaba ◽  
Aziz Momin ◽  
John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Cardiovascular Death ◽  
Good Effect ◽  
Complex Forms

Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

Sign in / Sign up

Export Citation Format

Share Document