The effect of posterior wall isolation for persistent atrial fibrillation on recurrent arrhythmia

Tokioka, Sayuri; Fukamizu, Seiji; Kimura, T; Takahashi, Minoru; Kitamura, Τakeshi; Hojo, Rintaro

doi:10.1111/jce.14906

Cited by 18 publications

(9 citation statements)

References 32 publications

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“…Finally, it must be recognized that when treating advanced forms of AF, study endpoints should be considered accordingly. A recent observational study of 181 patients with PsAF (90 underwent PVI plus PWI) noted significantly less recurrent PsAF among those with PWI (5.6% vs. 20.9%, p = .002), but no difference in rate of pAF (16.7% vs. 20.9%, p = .47) or atrial tachycardia (8.9% vs. 5.5%, p = .38) 60 . It is important to consider than in patients with PsAF, while an occasional paroxysm of AF may be deemed a “failure” in the context of a clinical trial, the procedure may still result in significant clinical benefit.…”

Section: Ongoing Randomized Trialsmentioning

confidence: 98%

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

Clarke

Piccini

Friedman

2021

Cardiovasc electrophysiol

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The left atrial posterior wall has many embryologic, anatomic, and electrophysiologic characteristics, that are important for the initiation and maintenance of persistent atrial fibrillation. The left atrial posterior wall is a potential target for ablation in patients with persistent atrial fibrillation, a population in whom pulmonary vein isolation alone has resulted in unsatisfactory recurrence rates. Published clinical studies report conflicting results on the safety and efficacy of posterior wall isolation. Emerging technologies including optimized use of radiofrequency ablation, pulse field ablation, and combined endocardial/epicardial ablation may optimize approaches to posterior wall isolation and reduce the risk of injury to nearby structures such as the esophagus. Critical evaluation of future and ongoing clinical studies of posterior wall isolation requires careful scrutiny of many characteristics, including intraprocedural definition of posterior wall isolation, concomitant extrapulmonary vein ablation, and study endpoints.

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Section: Ongoing Randomized Trialsmentioning

confidence: 98%

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

Clarke

Piccini

Friedman

2021

Cardiovasc electrophysiol

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“…This may, in part, be due to the lack of a standardised approach to posterior wall isolation, which is evidenced by the various lesion sets used in published studies. These approaches to posterior wall isolation include a single ring around the PVs and posterior left atrium [ 39 ], linear lesions (left atrial roof and posterior-inferior) to create the so-called posterior ‘box’ lesion [ 37 , 38 , 40 , 41 ], or extensive point-by-point radiofrequency [ 42 ] or segmental cryoballoon ablation [ 43 , 44 ] to debulk the posterior wall. Adjunctive lesions also vary among these studies.…”

Section: The Posterior Wall Of the Left Atrium In Non-paroxysmal Atrial Fibrillationmentioning

confidence: 99%

Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

Kaba

Momin

Camm

2021

JCM

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Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

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“…Nearly 70% of patients in their study demonstrated reconnection of the roof line or recurrence of electrical activity within the PW that led to AF and AFL. Sayuri et al showed a reconnection of PW in 65% of patients after the second procedure [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Extensive Posterior Wall Isolation on Top of Pulmonary Vein Isolation Guided by Ablation Index in Persistent Atrial Fibrillation Ablation

Sabatino

Oriente

Fortunato

et al. 2023

Life

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Background: Durable pulmonary vein isolation (PVI) is recommended for symptomatic paroxysmal atrial fibrillation (AF) treatment, but it has been demonstrated that it may not be enough to treat persistent AF (Pe-AF). Therefore, posterior wall isolation (PWI) is among the strategies adopted on top of PVI to treat Pe-AF patients. However, PWI using contiguous and optimized radiofrequency lesions remains challenging, and few studies have evaluated the impact of the Ablation Index (AI) on the efficacy of PWI. Moreover, previous papers did not evaluate arrhythmia recurrences using continuous monitoring. Methods: This is a prospective, observational, single-center study on patients affected by Pe-AF undergoing treated PVI plus AI-guided PWI. Procedures were performed using the CARTO mapping system, SmartTouch SF ablation catheter, and PentaRay multipolar mapping catheter. The AI settings were 500–550 for the anterior PV aspect and roofline, while the settings were 450–500 for the posterior PV aspect, bottom line, and/or PW lesions. All patients received an implantable loop recorder (ILR). All patients underwent clinical evaluation in the outpatient clinic at 1, 3, 6, 12, 18, and 24 months. A standard 12-lead ECG was performed at each visit, and device data from the ILR were reviewed to assess for arrhythmia recurrence. Results: Between January 2021 and December 2021, forty-one consecutive patients underwent PVI plus PWI guided by AI at our center and were prospectively enrolled in the study. PVI was achieved in all patients, first-pass roofline block was obtained in 82.9% of the patients, and first-pass block of the bottom line was achieved in 36.5% of the patients. In 39% of the patients, PWI was not performed with a “box-only” lesion set, but with scattered lesions across the PW to achieve PWI. AI on the anterior aspect of the left PVs was 528 ± 22, while on the posterior aspect of the left PVs, it was 474 ± 18; on the anterior aspect of the right PVs, it was 532 ± 27, while on the posterior aspect of the right PVs, it was 477 ± 16; on the PW, AI was 468 ± 19. No acute complications occurred at the end of the procedure. After the blanking period, 70.7% of the patients reported no arrhythmia recurrence during the 12-month follow-up period. Conclusions: In patients with Pe-AF undergoing catheter ablation, PWI guided by AI seems to be an effective and feasible strategy in addition to standard PVI.

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The effect of posterior wall isolation for persistent atrial fibrillation on recurrent arrhythmia

Cited by 18 publications

References 32 publications

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

Extensive Posterior Wall Isolation on Top of Pulmonary Vein Isolation Guided by Ablation Index in Persistent Atrial Fibrillation Ablation

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