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Impact of Posterior Wall Isolation During AF Ablation on the Incidence of Left Atrial Flutter.
Lim, Michael W; Morton, Matthew; Fernando, Romaniya; Elbracht-Leong, Stefanie; Better, Nathan; Segan, Louise; William, Jeremy; Crowley, Rose; Morton, Joseph B; Sparks, Paul B; Lee, Geoffrey; McLellan, Alex J; Ling, Liang-Han; Sugumar, Hariharan; Prabhu, Sandeep; Voskoboinik, Aleksandr; Kalman, Jonathan M; Kistler, Peter M.
Afiliación
  • Lim MW; The Alfred Hospital, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.
  • Morton M; Monash University, Melbourne, Australia.
  • Fernando R; Cabrini Health, Melbourne, Australia.
  • Elbracht-Leong S; Cabrini Health, Melbourne, Australia.
  • Better N; The Royal Melbourne Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne, Australia.
  • Segan L; The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.
  • William J; The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.
  • Crowley R; The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.
  • Morton JB; The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia.
  • Sparks PB; The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia.
  • Lee G; The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
  • McLellan AJ; The Royal Melbourne Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; St Vincent's Health, Melbourne, Victoria, Australia.
  • Ling LH; The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia.
  • Sugumar H; The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; Monash University, Melbourne, Australia; St Vincent's Health, Melbourne, Victoria, Australia.
  • Prabhu S; The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.
  • Voskoboinik A; The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Western Health, Melbourne, Victoria, Australia.
  • Kalman JM; The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Monash University, Melbourne, Australia.
  • Kistler PM; The Alfred Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Monash University, Melbourne, Australia. Electronic
JACC Clin Electrophysiol ; 10(7 Pt 2): 1620-1630, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38752960
ABSTRACT

BACKGROUND:

Linear and complex electrogram ablation (LCEA) beyond pulmonary vein isolation (PVI) is associated with an increase in left atrial macro-re-entrant tachycardias (LAMTs). Posterior wall isolation (PWI) is increasingly performed to improve AF ablation outcomes. However, the impact of PWI on the incidence of LAMT is unknown.

OBJECTIVES:

The purpose of this study was to establish the incidence of LAMT following PVI alone vs PVI + PWI vs PVI + PWI + LCEA.

METHODS:

Consecutive patients undergoing catheter ablation for AF or LAMT post-AF ablation between 2008 and 2022 from 4 electrophysiology centers were reviewed with a minimum follow-up of 12 months.

RESULTS:

In total, 5,619 (4,419 index, 1,100 redo) AF ablation procedures were performed in 4,783 patients (mean age 60.9 ± 10.6 years, 70.7% men). Over a mean follow-up of 6.4 ± 3.8 years, 246 procedures for LAMT were performed in 214 patients at a mean of 2.6 ± 0.6 years post-AF ablation. Perimitral (52.8% of patients), roof-dependent (27.1%), PV gap-related (17.3%), and anterior circuits (8.9%) were most common, with 16.4% demonstrating multiple circuits. The incidence of LAMT was significantly higher following PVI + PWI (6.2%) vs PVI alone (3.0%; P < 0.0001) and following PVI + PWI + LCEA vs PVI + PWI (12.5%; P = 0.019). Conduction gaps in previous ablation lines were responsible for LAMT in 28.4% post-PVI alone, 35.3% post-PVI + PWI (P = 0.386), and 81.8% post-PVI + PWI + LCEA (P < 0.005).

CONCLUSIONS:

The incidence of LAMT following PVI + PWI is higher than with PVI alone but significantly lower than with more extensive atrial substrate modification. Given a low frequency of LAMT following PWI, empiric mitral isthmus ablation is not justified and may be proarrhythmic.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Aleteo Atrial / Ablación por Catéter Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: JACC Clin Electrophysiol Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Aleteo Atrial / Ablación por Catéter Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: JACC Clin Electrophysiol Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos