Impact of the size of non-ablated left atrial posterior wall area on outcomes after extensive encircling pulmonary vein isolation

Yoshimura, Shingo; Kaseno, Kenichi; Kimura, Kohki; Sasaki, Wataru; Okazaki, Yoshimasa; Haraguchi, Yumiko; Kishi, Shohei; Sasaki, Takehito; Goto, Koji; Miki, Yuko; Take, Yutaka; Nakamura, Kohki; Naito, Shigeto

doi:10.1007/s00380-021-01820-3

Cited by 5 publications

(6 citation statements)

References 28 publications

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“…In the present study, both the rate of first-pass isolation and long-term clinical outcomes of the ablation procedures were not associated with the width of antral isolation, differing from the findings of the previous two studies [ 4 , 16 ]. Although the range of the distance and the area between ablation lines were considerable (even if indexed to left atrial dimensions), it is possible that the single-centre single-operator study lacked the necessary variability.…”

Section: Discussioncontrasting

confidence: 99%

“…It can also be easily adopted in clinical settings since the measurement of the distance and the area between ablation lines on the posterior wall is not as difficult as delineation of the PV ostia. The mean value of the non-isolated posterior wall area in the whole group in the present study was similar to the findings of Kiuchi et al [ 4 ] and greater than in the study of Yoshimura et al [ 16 ]; the latter could have been influenced by ethnic differences.…”

Section: Discussionsupporting

confidence: 91%

“…It is probable that adopting this technique allows for performing PVI less dependably from the specific site of ablation. However, in the study by Yoshimura et al, the prognostic value of the size of the non-isolated left atrial posterior wall was tested in 132 patients with non-paroxysmal AF who underwent ablation index-guided pulmonary vein isolation [ 16 ]. In the group with recurrence of atrial arrhythmia, the non-isolated posterior wall area was significantly greater than in patients without recurrences: 10.9 ± 3.5 cm 2 and 8.2 ± 3.2 cm 2 , respectively, and 8.6 ± 3.3 cm 2 for the whole group.…”

Section: Discussionmentioning

confidence: 99%

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The Importance of a Distance between the Lines Encircling Pulmonary Veins in Atrial Fibrillation Ablation on First-Pass Isolation Ratio and Clinical Outcomes

Krzyżanowski

Kiliszek

Uziębło‐Życzkowska

et al. 2023

IJERPH

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Introduction: How wide the encircling line is made may influence the outcomes of pulmonary vein isolation (PVI). In the present study we hypothesised that the distance between the lines encircling the pulmonary veins may correspond with the extent of wide antral circumferential ablation (WACA). The aim of the study was to assess the impact of the distance and the area between the lines on the posterior wall of the left atrium on first-pass isolation rate and 12-month freedom from atrial arrhythmia in patients undergoing PVI ablation. Methods and results: One hundred sixteen patients underwent circumferential ablation index (AI)-guided PVI. The distance between the encircling ablation lines was measured off-line between the uppermost points (right and left) and the lowest points and as the area between the encircling lines on the posterior wall. The first-pass isolation rate and 12-month freedom from atrial arrhythmia were 59% and 73%, respectively. Distance between the encircling lines measured linearly or as the area of the posterior wall, assessed as direct values or indexed to left atrial dimensions, did not differ between patients with and without first-pass isolation or between patients with and without recurrences of atrial arrhythmia. Conclusions: The distance between the ablation lines did not influence the rate of first-pass isolation and arrhythmia recurrence in the long-term follow-up after PVI procedures incorporating the ablation index protocol.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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The Importance of a Distance between the Lines Encircling Pulmonary Veins in Atrial Fibrillation Ablation on First-Pass Isolation Ratio and Clinical Outcomes

Krzyżanowski

Kiliszek

Uziębło‐Życzkowska

et al. 2023

IJERPH

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“…This is suggested by the fact that the difference in non-isolated LAPW is larger than the difference in IASA of total PV between the LBA and CBA groups. A large isolated posterior antral surface area has been reported to have a lower recurrence rate after AF ablation [ 18 , 19 ]. We, therefore, hope that this method will contribute to reducing the recurrence rate of AF.…”

Section: Discussionmentioning

confidence: 99%

Comparison of maximum-sized visually guided laser balloon and cryoballoon ablation

et al. 2022

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Balloon ablation therapy has recently been used for atrial fibrillation (AF) ablation. Laser balloons possess the property in which the balloon size can be changed. Standard laser balloon ablation (Standard LBA) was followed by additional ablation using a maximally extended balloon (Extended LBA) and its lesion characteristics were compared to cryoballoon ablation (CBA), another balloon technology. From June 2020 to July 2021, patients with paroxysmal AF who underwent an initial pulmonary vein (PV) isolation were enrolled. Sixty-five patients with paroxysmal AF were included, 32 in the LBA and 33 in the CBA group. To measure the isolated surface area after the ablation procedures, left atrial voltage mapping was performed after Standard LBA, Extended LBA, and CBA. The baseline patient characteristics did not differ between LBA and CBA. Extended LBA could successfully increase the isolated area more than Standard LBA for all four PVs. Compared to CBA, the isolated area of both superior PVs was significantly greater with Extended LBA (left superior PV: 8.5 ± 2.1 vs 7.3 ± 2.4, p = 0.04, right superior PV: 11.4 ± 3.7 vs 8.7 ± 2.7, p < 0.01), and thus the non-isolated posterior wall (PW) was smaller (8.5 ± 3.4 vs 12.4 ± 3.3, p < 0.01). Nevertheless, changes in the cardiac injury markers were significantly lower with LBA than CBA. There was no significant correlation between the cardiac injury level and isolated area in both groups. In conclusion, Extended LBA exhibited a significantly greater isolation of both superior PVs and resulted in a smaller non-isolated PW, but the cardiac injury markers were significantly suppressed as compared to CBA.

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“…The procedural protocol has been described in a previously documented report 11 . Before the ablation procedure, comprehensive assessments of the LA, pulmonary vein (PV), and esophageal anatomy were conducted using contrast‐enhanced CT.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of radiofrequency lesions in patients with symptomatic periesophageal vagal nerve injury after pulmonary vein isolation

Yoshimura,

Take,

Kaseno

et al. 2024

Journal of Arrhythmia

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BackgroundPeriesophageal vagal nerve injury (PNI) is an unpredictable and serious complication of atrial fibrillation (AF) ablation. We aimed to identify the factors associated with symptomatic PNI.MethodsThis study included 1391 patients who underwent ablation index‐guided pulmonary vein isolation (PVI) using the CARTO system. The target ablation index was set at 550, except for the left atrial (LA) posterior wall near the esophagus, where radiofrequency (RF) power and duration were limited. Ten patients (0.72%) were diagnosed with symptomatic PNI. We randomly selected 40 patients without PNI (1:4 ratio) matched based on age, sex, body mass index, LA diameter, type of AF, and esophageal location. We measured the shortest distance from the RF lesions to the esophagus (LED) and classified the RF lesions according to the LED into four groups: 0–5, 5–10, 10–15, and 15–20 mm. We conducted a comparative analysis of classified RF lesions between patients with PNI (n = 10) and those without (n = 40).ResultsThe contact force at LED 0–5 mm was significantly higher in patients with PNI than in those without (14.6 ± 1.7 vs. 12.0 ± 2.9 g; p = .01). Multivariate logistic analysis revealed that the independent factor for PNI was contact force at an LED of 0–5 mm (odds ratio: 1.506; 95% confidence interval: 1.053–2.153; p = .025).ConclusionsThe symptomatic PNI was significantly associated with a higher contact force near the esophagus. Strategies for regulating contact force near the esophagus may aid in the prevention of PNI.

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Impact of the size of non-ablated left atrial posterior wall area on outcomes after extensive encircling pulmonary vein isolation

Cited by 5 publications

References 28 publications

The Importance of a Distance between the Lines Encircling Pulmonary Veins in Atrial Fibrillation Ablation on First-Pass Isolation Ratio and Clinical Outcomes

The Importance of a Distance between the Lines Encircling Pulmonary Veins in Atrial Fibrillation Ablation on First-Pass Isolation Ratio and Clinical Outcomes

Comparison of maximum-sized visually guided laser balloon and cryoballoon ablation

Characteristics of radiofrequency lesions in patients with symptomatic periesophageal vagal nerve injury after pulmonary vein isolation

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