The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and <scp>meta‐analysis</scp> of randomized controlled trials

Kanitsoraphan, Chanavuth; Rattanawong, Pattara; Techorueangwiwat, Chol; Kewcharoen, Jakrin; Mekritthikrai, Raktham; Prasitlumkum, Narut; Shah, Parthav; Masry, Hicham El

doi:10.1002/joa3.12698

Cited by 12 publications

(16 citation statements)

References 42 publications

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“…Several studies have demonstrated the feasibility of PWI for catheter ablation of Pe-AF [ 7 , 8 , 9 , 10 , 11 ]. These findings were confirmed in a recent metanalysis of multiple randomized clinical trials, demonstrating the incremental benefit of PWI [ 24 ]. However, how to perform isolation of LPW remains a very debatable, controversial issue.…”

Section: Discussionmentioning

confidence: 53%

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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Section: Discussionmentioning

confidence: 53%

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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“…It has been observed that arrhythmogenic foci, fibrotic area, and ganglionate plexi are located predominantly around the pulmonary veins and on the posterior wall of the left atrium [ 8 , 9 , 10 ]. The same theory led to the conception of routine posterior wall isolation for atrial fibrillation ablation, but randomised studies have yielded conflicting results [ 11 , 12 , 13 ]. Therefore, it is of great importance to find the optimal width for antral circumferential ablation around the pulmonary veins.…”

Section: Discussionmentioning

confidence: 99%

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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“…Moving to the ablation of posterior atrial wall box isolation on top of circumferential PVI, no effect on the clinical outcomes was noted [ 116 ]. However, a recent meta-analysis showed that posterior atrial wall isolation could reduce AF recurrence compared to the control group in patients with persistent AF [ 117 ]. Valderrábano et al investigated the retrograde ethanol infusion in the vein of Marshall, which is perceived as an AF triggering point, and showed that patients with persistent AF randomized to this procedure had a lower rate of atrial tachyarrhythmia recurrence and AF burden compared to conventional RF ablation, without any excess adverse events [ 118 ].…”

Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 99%

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

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Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.

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The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials

Cited by 12 publications

References 42 publications

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

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

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

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

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