Residual potential at the epicardial left atrium after conventional left atrial posterior wall isolation for persistent atrial fibrillation: A case report

Arai, Toshiyasu; Fukamizu, Seiji; Kitamura, Τakeshi; Hojo, Rintaro

doi:10.1002/joa3.12365

Cited by 2 publications

(4 citation statements)

References 5 publications

(5 reference statements)

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“…However, the endocardial bipolar voltage amplitude is mainly derived from the atrial tissue in proximity to the mapping catheter and may not be sufficient to evaluate the formation of transmural lesions. A recent study showed asynchronous activation of the endo epicardial wall during AF in humans 11 and cases in which the residual epicardial bipolar potential remained even though PWI was achieved from the endocardial side 4 . Endocardial unipolar voltage mapping can identify substrates under the endocardium, and several studies have demonstrated the utility of endocardial unipolar voltage for the detection of intramural and epicardial scars 12,13 …”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed asynchronous activation of the endo epicardial wall during AF in humans 11 and cases in which the residual epicardial bipolar potential remained even though PWI was achieved from the endocardial side. 4 Endocardial unipolar voltage mapping can identify substrates under the endocardium, and several studies have demonstrated the utility of endocardial unipolar voltage for the detection of intramural and epicardial scars. 12,13 The results of this study indicate that the conventional evaluation method based on bipolar voltage amplitude is insufficient for evaluating transmural lesions of PWI and that utilizing unipolar voltage amplitude, which allows evaluation of more far-field potentials, may be useful for improving the outcome of PWI.…”

Section: Usefulness Of Bipolar Voltage Mappingmentioning

confidence: 99%

“…However, when performing PWI, it is sometimes difficult to create a transmural lesion with subendocardial ablation. We encountered a case in which left atrial PWI was achieved on the endocardial side, but extensive residual potentials remained on the epicardial side 4 . Currently, there is no established method to evaluate whether a transmural lesion has been created from the endocardial side.…”

Section: Introductionmentioning

confidence: 99%

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Association between residual unipolar voltage and arrhythmia recurrence after left atrial posterior wall isolation for persistent atrial fibrillation

Kujiraoka

Hojo

Arai

et al. 2023

Cardiovasc electrophysiol

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IntroductionPosterior wall isolation (PWI) combined with pulmonary vein isolation (PVI) has proven effective for persistent atrial fibrillation (AF). However, when performing PWI, creating transmural lesions with subendocardial ablation is sometimes difficult. Endocardial unipolar voltage amplitude had a higher sensitivity than bipolar voltage mapping for identifying intramural viable myocardium in the atria. In this study, we aimed to retrospectively investigate the correlation between the residual potential in the posterior wall (PW) following PWI for persistent AF and atrial arrhythmia recurrence using endocardial unipolar voltage.MethodsThis was a single‐center observational study. Patients who underwent PVI and PWI for persistent AF in the first procedure between March 2018 and December 2021 at the Tokyo Metropolitan Hiroo Hospital were included in this study. The patients were divided into two groups based on the presence of residual unipolar PW potentials after PWI with a cutoff of 1.08 mV and the recurrence of atrial arrhythmias was compared.ResultsIn total, 109 patients were included in the analysis. Forty‐three patients had residual unipolar potentials after PWI and 66 patients had no residual unipolar potentials. The atrial arrhythmia recurrence rate was significantly higher in the group with residual unipolar potential (41.8% vs. 17.9%, p = 0.003). The residual unipolar potential was an independent predictor of recurrence (odds ratio: 4.53; confidence interval: 1.67–12.3, p = 0.003).ConclusionResidual unipolar potential after PWI for persistent AF is associated with recurrent atrial arrhythmias.

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Section: Discussionmentioning

confidence: 99%

Section: Usefulness Of Bipolar Voltage Mappingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between residual unipolar voltage and arrhythmia recurrence after left atrial posterior wall isolation for persistent atrial fibrillation

Kujiraoka

Hojo

Arai

et al. 2023

Cardiovasc electrophysiol

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“…In some studies, residual potentials were observed on the epicardial side of left atrial posterior wall even after confirmation of posterior wall isolation by endocardial mapping, which could conduct into the left atrium and contribute to the recurrence of AF. After posterior left atrial wall isolation, there have been reports suggesting that residual potentials in the unipolar voltage maps may be associated with the recurrence of AF ( 30 , 31 ). Creating transmural lesions in the left atrial posterior wall can be challenging due to the presence of the septo-pulmonary bundle and the proximity of the esophagus ( 32 ).…”

Section: Posterior Wall Isolation For Persistent Afmentioning

confidence: 99%

Hybrid ablation for persistent atrial fibrillation: a narrative review

Kataoka,

Shoda,

Ejima

et al. 2024

J Thorac Dis

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Background and Objective Treatment for atrial fibrillation (AF) has evolved significantly, with pulmonary vein isolation (PVI) becoming an established treatment. However, the outcomes following catheter ablation for persistent AF remain unsatisfactory. Hybrid catheter-surgical ablation has emerged as a therapeutic approach for persistent AF, combining the strengths of both interventions. The purpose of this narrative review is to comprehensively examine the current state of knowledge regarding hybrid ablation for AF. Methods A thorough PubMed search using the terms “hybrid ablation”, “atrial fibrillation”, “catheter ablation”, and “guideline on cardiology” within the timeframe of 1980 to 2024 resulted in 138,969 articles. Consensus on the selected articles was reached through a series of structured meetings and discussions. Key Content and Findings PVI has demonstrated higher sinus rhythm maintenance rates, especially for paroxysmal AF. However, the efficacy is not as high for persistent AF. Additional ablation strategies, such as linear ablation, complex fractionated atrial electrogram ablation, low voltage zone ablation as well as posterior wall isolation, lack consistent evidence of effectiveness. Hybrid ablation, involving collaboration between cardiac surgeons and electrophysiologists, presents a promising alternative for hard-to-treat AF. Recent studies report favorable outcomes of hybrid ablation, with atrial arrhythmia-free rates ranging from 53.5% to 76%, surpassing those of catheter ablation alone, which might result from better lesion durability or intervention for non-PV foci and left atrial appendage excision or closure during hybrid ablation. The rate of complications associated with hybrid ablation is higher than catheter ablation alone. Conclusions While favorable outcomes of hybrid ablation for persistent AF have been reported, it is not recommended for all AF patients due to its invasiveness compared to catheter ablation. Additionally, some patients with persistent AF maintain sinus rhythm with catheter ablation alone. More clinical data are needed to determine which patients are suitable candidates for hybrid ablation.

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Residual potential at the epicardial left atrium after conventional left atrial posterior wall isolation for persistent atrial fibrillation: A case report

Cited by 2 publications

References 5 publications

Association between residual unipolar voltage and arrhythmia recurrence after left atrial posterior wall isolation for persistent atrial fibrillation

Association between residual unipolar voltage and arrhythmia recurrence after left atrial posterior wall isolation for persistent atrial fibrillation

Hybrid ablation for persistent atrial fibrillation: a narrative review

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