Does isolation of the left atrial posterior wall improve clinical outcomes after radiofrequency catheter ablation for persistent atrial fibrillation?

Kim, Jin-Seok; Shin, Seung Yong; Na, Jin Oh; Choi, Cheol Ung; Kim, Seong Hwan; Kim, Jin Won; Kim, Eung Ju; Rha, Seung–Woon; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Hwang, Chun; Lim, Hong Euy

doi:10.1016/j.ijcard.2014.12.035

Cited by 128 publications

(90 citation statements)

References 38 publications

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“…In a prospective randomized trial, PVI with additional isolation of the left atrial posterior wall reduced arrhythmia recurrence after 12 months of follow-up [25]. Furthermore, the addition of linear lesions in the left atrium improved outcome in a recent meta-analysis [6].…”

Section: Persistent Atrial Fibrillation: Is Atrial Substrate Modificamentioning

confidence: 98%

What have we learned of ablation procedures for atrial fibrillation?

Maurer

Tilz

et al. 2016

J Intern Med

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Section: Persistent Atrial Fibrillation: Is Atrial Substrate Modificamentioning

confidence: 98%

What have we learned of ablation procedures for atrial fibrillation?

Maurer

Tilz

et al. 2016

J Intern Med

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“…[13][14][15][16][17][18][19] Advanced atrial remodeling in AF and the embryological origin of the left atrial appendage from the primitive left atrium, which in turn is formed by the adsorption of the primordial PVs and their branches, are believed to be important causative mechanisms underlying the origin of non-PV triggers. 13,15,18,77 Further evidence came from the results of the recently presented randomized bELIEF: Empirical LAA Isolation in pErsistent atrial Fibrillation that demonstrated that empirical left atrial Figure 6. phase map shows a focal source that emanates an impulse from the right inferior pulmonary vein (RIpV) and initiates a couple ( figure-of-8) of reentrant drivers.…”

Section: 53-55mentioning

confidence: 99%

“…5 It is now clear that other sites beside the PVs can trigger AF. [13][14][15][16][17][18][19][20] Alteration of atrial substrate and elimination of PV and non-PV triggers have remained the 2 basic philosophies in AF ablation. Patients with paroxysmal AF may have triggers only; those with nonparoxysmal AF are more likely to have abnormalities of the atrial substrate.…”

mentioning

confidence: 99%

Ablation of Atrial Fibrillation

2016

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Atrial fibrillation (AF) is the most common arrhythmia encountered by cardiologists and is a major cause of morbidity and mortality. Risk factors for AF include age, male sex, genetic predisposition, hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, heart failure, and possibly excessive exercise. The management of AF involves decisions about rate versus rhythm control. Asymptomatic patients are generally managed with rate control and anticoagulation. Symptomatic patients will desire rhythm control. Rhythm control options are either antiarrhythmic agents or ablation, with each having its own risks and benefits. Ablation of AF has evolved from a rare and complex procedure to a common electrophysiological technique. Selection of patients to undergo ablation is an important aspect of AF care. Patients with the highest success rates of ablation are those with normal structural hearts and paroxysmal AF, although those with congestive heart failure have the greatest potential benefit of the procedure. Although pulmonary vein isolation of any means/energy source is the approach generally agreed on for those with paroxysmal AF, optimal techniques for the ablation of nonparoxysmal AF are not yet clear. Anticoagulation reduces thromboembolic complications; the newer anticoagulants have eased management for both the patient and the cardiologist. Aggressive management of modifiable risk factors (hypertension, diabetes mellitus, sleep apnea, obesity, excessive alcohol, smoking, hyperthyroidism, pulmonary disease, air pollution, and possibly excessive exercise) after ablation reduces the odds of recurrent AF and is an important element of care.

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“…Left atrial posterior wall isolation (LAPWI) has been part of the surgical Maze procedure and has yielded good results as an open surgical procedure . Although LAPWI is challenging to achieve with the use of endocardial catheter ablation, some previous studies have reported the effectiveness of LAPWI to suppress AF recurrence after catheter ablation . However, the mechanisms of the AF‐suppressing effects of LAPWI are still unclear.…”

Section: Introductionmentioning

confidence: 99%

Left atrial posterior wall isolation affects complex fractionated atrial electrograms in persistent atrial fibrillation

Nakatani

Sakamoto

Yamaguchi

et al. 2019

Journal of Arrhythmia

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Background The impact of left atrial posterior wall isolation ( LAPWI ) on the complex fractionated atrial electrogram ( CFAE ) is unknown. Methods CFAE mapping was performed before and after LAPWI in 46 patients with persistent atrial fibrillation ( AF ). Results LAPWI decreased both the variable (fractionated index ≤ 120 ms; from 60 ± 4 cm 2 to 50 ± 4 cm 2 , P < 0.001) and continuous (fractionated index ≤ 50 ms; from 4.2 ± 1.0 cm 2 to 3.5 ± 0.9 cm 2 , P = 0.036) CFAE areas. Especially, the CFAE areas on the bottom and roof walls of the left atrium and on the posterior and bottom walls of the right atrium significantly decreased after LAPWI . The distribution of variable CFAE areas was not different between the AF ‐recurrence (n = 9) and AF ‐free (n = 37) groups before LAPWI ; however, it was larger in the anterior and septal walls of the right atrium in the AF ‐recurrence group than in the AF ‐free group after LAPWI (anterior wall, 8% ± 2% vs 5% ± 1%, P = 0.048; septal wall, 23% ± 4% vs 16% ± 1%, P = 0.043). The distribution of continuous CFAE areas on the bottom wall of the right atrium was larger in the AF ‐recurrence group than in the AF ‐free group both before LAPWI (30% ± 20% vs 4% ± 2%, P = 0.008) and after LAPWI (25% ± 25% vs 3% ± 1%, P = 0.027). Conclusions LAPWI decreased the CFAE areas and affected their distribution, which contributed to AF recurrence.

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Does isolation of the left atrial posterior wall improve clinical outcomes after radiofrequency catheter ablation for persistent atrial fibrillation?

Cited by 128 publications

References 38 publications

What have we learned of ablation procedures for atrial fibrillation?

What have we learned of ablation procedures for atrial fibrillation?

Ablation of Atrial Fibrillation

Left atrial posterior wall isolation affects complex fractionated atrial electrograms in persistent atrial fibrillation

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