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Acute left atrial ridge lesion after cryoballoon ablation: How it affects left atrial appendage closure combined procedure?
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  • Zhongyuan Ren,
  • Peng Jia,
  • Songyun Wang,
  • Shang Li,
  • Hailing Li,
  • Rong Guo,
  • Jingying Zhang,
  • Jun Zhang,
  • Haotian Yang,
  • Weilun Meng,
  • Yixing Zheng,
  • Yawei Xu,
  • Dongdong Zhao
Zhongyuan Ren
Shanghai Tenth People's Hospital
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Peng Jia
Shanghai Tenth People's Hospital
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Songyun Wang
Renmin hospital of Wuhan University
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Shang Li
Shanghai Tenth People's Hospital
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Hailing Li
Shanghai Tenth People's Hospital
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Rong Guo
Shanghai Tenth People's Hospital
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Jingying Zhang
Shanghai Tenth People's Hospital
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Jun Zhang
Shanghai Tenth People's Hospital
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Haotian Yang
Shanghai Tenth People's Hospital
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Weilun Meng
Shanghai Tenth People's Hospital
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Yixing Zheng
Shanghai Tenth People's Hospital
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Yawei Xu
Shanghai Tenth People's Hospital
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Dongdong Zhao
Shanghai Tenth People's Hospital
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Abstract

Background: Acute left atrial ridge (LAR) lesion was observed after atrial fibrillation ablation. However, the feature of LAR lesion has not been quantitatively evaluated and its influence on left atrial appendage closure (LAAC) combined procedure remained to be explored. We aimed to evaluate profile of acute LAR lesion and investigate its influence on LAAC procedure. Methods: LAR lesion profile was measured by transesophageal echocardiography (TEE) in 117 consecutive non-valvular AF patients underwent combined procedure of cryoballoon (CB) ablation and LAAC. Its correlation with baseline variables and clinical outcomes were thoroughly investigated. Results: Measurement of 96 available TEE image series showed 95 had prominent acute LAR lesion, with a greater change in width (Δwidth=3.6±2.3 mm) than thickness (Δthickness=2.6±3.5 mm), and correspondingly narrowed outer ostium (Δouter ostium diameter=-3.4±4.0 mm). While the inner ostium stayed unchanged. Logistic regression analysis showed that a higher nadir temperature when freezing left superior pulmonary vein (LSPV) led to a LAR lesion with greater width (2-fold wider) (adjusted odds ratio =1.16, 95% confidence interval 1.02-1.31). For evaluation of LAAC outcomes, residual flow occurred in 6 patients, 4 with Watchman had minimal residual flow at the inferior border, while 2 with LAmbre developed larger residual flow at the LAR side. Clinical outcomes were similar between groups divided by LAR lesion size. Conclusion: Acute LAR lesion frequently occurred following CB ablation combined procedure, and its width positively correlates with LSPV nadir temperature. It affects measurement of pacifier device but has no influence on plug device when performing combined procedure.

Peer review status:ACCEPTED

11 Jun 2020Submitted to Journal of Cardiovascular Electrophysiology
11 Jun 2020Submission Checks Completed
11 Jun 2020Assigned to Editor
14 Jun 2020Reviewer(s) Assigned
30 Jun 2020Review(s) Completed, Editorial Evaluation Pending
30 Jun 2020Editorial Decision: Revise Minor
22 Jul 20201st Revision Received
27 Jul 2020Assigned to Editor
27 Jul 2020Submission Checks Completed
27 Jul 2020Reviewer(s) Assigned
31 Jul 2020Review(s) Completed, Editorial Evaluation Pending
02 Aug 2020Editorial Decision: Revise Minor
03 Aug 20202nd Revision Received
03 Aug 2020Submission Checks Completed
03 Aug 2020Assigned to Editor
03 Aug 2020Reviewer(s) Assigned
08 Aug 2020Review(s) Completed, Editorial Evaluation Pending
11 Aug 2020Editorial Decision: Accept