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Anatomical insights into modified posterior-inferior line in patients with atrial fibrillation: Implications in left atrial posterior wall isolation
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  • Xiaofeng Lu,
  • Shi Peng,
  • Xiaoyu Wu,
  • Genqing Zhou,
  • Yong Wei,
  • Lidong Cai,
  • Juan Xu,
  • Yu Ding,
  • Songwen Chen,
  • Shaowen Liu
Xiaofeng Lu
Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China
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Shi Peng
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
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Xiaoyu Wu
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
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Genqing Zhou
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
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Yong Wei
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
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Lidong Cai
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
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Juan Xu
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
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Yu Ding
Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine
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Songwen Chen
1. Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine.
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Shaowen Liu
Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine
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Abstract

Introduction Left atrial posterior wall (LAPW) isolation may be performed as an additional atrial fibrillation (AF) ablation strategy based on pulmonary vein isolation. A modified posterior-inferior line (MPL) was proposed for reducing esophageal injury. The aim of this study was to evaluate the anatomical characteristics of the MPL, compared with the CPL. Methods and Results Multidetector computed tomography was performed in 102 consecutive AF patients (male/female = 60/42) preoperative, and the parameters were evaluated as follows: the distance from MPL and CPL to the esophagus, fat pad presence and thickness in the course of MPL and CPL, and the esophageal route below CPL. The average distance from the MPL to the esophagus was longer than from CPL to the esophagus (3.7 ± 1.5mm vs 1.7 ± 0.4mm, P < 0.001). Fat pad presence was higher in the course of MPL than CPL. The myocardium tissue and fat pad under MPL was thicker than under CPL (2.9 ± 1.1mm vs 1.6 ± 0.3mm, P < 0.001; 1.4 ± 0.6mm vs 0.9 ± 0.2mm, P < 0.001), respectively. In patients whose esophagus was unconfined in a triangular space at the left inferior pulmonary vein level, the average distance from MPL to esophagus was longer than the confined patients (4.0 ± 1.7mm vs 3.2 ± 1.0mm, P = 0.001). Conclusion The MPL was far away from the esophagus with thicker myocardium tissue and more fat pad than the CPL; thus, MPL could serve as a favorable alternative in linear ablation for LAPW isolation.

Peer review status:UNDER REVIEW

30 Aug 2020Submitted to Journal of Cardiovascular Electrophysiology
31 Aug 2020Assigned to Editor
31 Aug 2020Submission Checks Completed
01 Sep 2020Reviewer(s) Assigned