Additional left atrial septal line does not improve outcome of patients undergoing ablation for long-standing persistent atrial fibrillation

Abstract

In patients with long-standing AF, an additional LA septal linear ablation is not associated with a significantly higher AF termination rate. A septal linear lesion might increase the risk of septal reentrant tachycardias, and is associated with a trend towards a worse outcome.

Approach to the Catheter Ablation Technique of Paroxysmal and Persistent Atrial Fibrillation: A Meta-Analysis of the Randomized Controlled Trials

“…This did not affect the overall result 33 . One study that was not included in the random effects models for linear lesions in persistent AF studied the effect of additional septal ablation in the LA beyond PVI, MI, and RL 37 . Mikhaylov et al .…”

“…33 One study that was not included in the random effects models for linear lesions in persistent AF studied the effect of additional septal ablation in the LA beyond PVI, MI, and RL. 37 Mikhaylov et al found no significant difference between the 2 groups after a single ablation (RR 21.14; 95% CI 0.53, 2.44) or multiple ablations (RR 2.13; 95% CI 0.52, 8.76). When multiple procedures are taken into account using this technique, 24,29,30,[34][35][36]38 the heterogeneity among the trials makes conclusions regarding the addition of linear lesions difficult.…”

Biatrial Tachycardia Following Linear Anterior Wall Ablation for the Perimitral Reentry: Incidence and Electrophysiological Evaluations

“…Conduction block over the AnL was confirmed using a combination of the following criteria: no electrical activity or corridor of double potentials along the line, pacing from both sides along the ablation line showed opposite activation on the CS catheter, and no atrial capture while pacing from the AnL. MI line verification has been described elsewhere …”

“…Alternative linear ablations have also been proposed to treat PMF. These include a left atrial (LA) anterior line, joining MI and LA roof line, or connecting mitral annulus and right pulmonary veins (PV) . In these areas catheter position is more stable, and catheter manipulation is less challenging.…”

Factors associated with the efficacy of atrial fibrillation radiofrequency catheter ablation: opinion of the specialists who use the “Ablation Index” module

“…It is known that the presence and severity of the electroanatomical substrate are responsible for AF recurrence after PVI alone [66]. On the other hand, empirical linear lesion, in the hope of modifying an additional arrhythmia substrate, in patients with persistent AF does not lead to an improvement in sinus rhythm maintenance [67,68]. At the same time, voltage-oriented RF modification of areas with a low signal amplitude (<0.5 mV at three nearby points) is associated with high rates of freedom from arrhythmia after one ablation procedure in patients without antiarrhythmic therapy during one year of follow-up and represents a personalized AF treatment approach [69].…”