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Original Article
Published online: 2020-12-16
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Posterior wall substrate modification using optimized and contiguous lesions in patients with atrial fibrillation

Christian Sohns, Leonard Bergau, Mustapha El Hamriti, Henrik Fox, Stephan Molatta, Martin Braun, Moneeb Khalaph, Guram Imnadze, Philipp Sommer
DOI: 10.5603/CJ.a2020.0180
·
Pubmed: 33346368

open access

Ahead of print
Original articles
Published online: 2020-12-16

Abstract

Background: Radiofrequency (RF) linear ablation at the left atrial (LA) roof and bottom to isolate the LA posterior wall using contiguous and optimized RF lesions was evaluated. Achieving isolation of the LA posterior wall is challenging as two continuous linear lesion sets are necessary.

Methods: Forty consecutive patients with symptomatic atrial fibrillation (AF) and arrhythmia substrates affecting the LA posterior wall underwent posterior wall isolation by linear lesions across the roof and bottom. The cohort was divided into two groups: group 1 (20 patients) linear ablation guided by contact force (CF) only; group 2 (20 patients) guided by ablation index (AI) and interlesion distance.

Results: Bidirectional block across the LA roof and bottom was achieved in 40/40 patients. Additional endocardial RF applications in 5 patients from group 1 vs. 3 patients from group 2 resulted in posterior wall isolation in all patients. Procedure duration was almost equal in both groups. CF and AI were significantly higher in group 2 for the roof line, whereas no statistical difference was found for the bottom line. AI-guided LA posterior wall isolation led to a significantly lower maximum temperature increase. The mean AI value as well as the mean value for catheter-to-tissue CF for the roof line were significantly higher when AI-guided ablation was performed. Standard deviation in group 2 showed a remarkably lower dispersion.

Conclusions: Ablation index guided posterior wall isolation for substrate modification is safe and effective. AI guided application of the posterior box lesion allows improved lesion formation.

Abstract

Background: Radiofrequency (RF) linear ablation at the left atrial (LA) roof and bottom to isolate the LA posterior wall using contiguous and optimized RF lesions was evaluated. Achieving isolation of the LA posterior wall is challenging as two continuous linear lesion sets are necessary.

Methods: Forty consecutive patients with symptomatic atrial fibrillation (AF) and arrhythmia substrates affecting the LA posterior wall underwent posterior wall isolation by linear lesions across the roof and bottom. The cohort was divided into two groups: group 1 (20 patients) linear ablation guided by contact force (CF) only; group 2 (20 patients) guided by ablation index (AI) and interlesion distance.

Results: Bidirectional block across the LA roof and bottom was achieved in 40/40 patients. Additional endocardial RF applications in 5 patients from group 1 vs. 3 patients from group 2 resulted in posterior wall isolation in all patients. Procedure duration was almost equal in both groups. CF and AI were significantly higher in group 2 for the roof line, whereas no statistical difference was found for the bottom line. AI-guided LA posterior wall isolation led to a significantly lower maximum temperature increase. The mean AI value as well as the mean value for catheter-to-tissue CF for the roof line were significantly higher when AI-guided ablation was performed. Standard deviation in group 2 showed a remarkably lower dispersion.

Conclusions: Ablation index guided posterior wall isolation for substrate modification is safe and effective. AI guided application of the posterior box lesion allows improved lesion formation.

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Keywords

atrial fibrillation, catheter ablation, posterior wall isolation, ablation index, contact force

About this article
Title

Posterior wall substrate modification using optimized and contiguous lesions in patients with atrial fibrillation

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-12-16

DOI

10.5603/CJ.a2020.0180

Pubmed

33346368

Keywords

atrial fibrillation
catheter ablation
posterior wall isolation
ablation index
contact force

Authors

Christian Sohns
Leonard Bergau
Mustapha El Hamriti
Henrik Fox
Stephan Molatta
Martin Braun
Moneeb Khalaph
Guram Imnadze
Philipp Sommer

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