loading page

Persistent Atrial Fibrillation Catheter Ablation Outcomes Stratified by Left Atrial Posterior Wall Isolation Lesion Set Characteristics
  • +6
  • Edward Kogan,
  • Robert Knotts,
  • Lior Jankelson,
  • Scott Bernstein,
  • David Park,
  • Douglas Holmes,
  • Anthony Aizer,
  • Larry Chinitz,
  • Chirag Barbhaiya
Edward Kogan
NYU Langone Health
Author Profile
Robert Knotts
NYU Langone Health
Author Profile
Lior Jankelson
NYU Langone Health
Author Profile
Scott Bernstein
NYU Langone Health
Author Profile
David Park
NYU Langone Health
Author Profile
Douglas Holmes
NYU Langone Health
Author Profile
Anthony Aizer
NYU Langone Health
Author Profile
Larry Chinitz
NYU Langone Health
Author Profile
Chirag Barbhaiya
NYU Langone Health
Author Profile

Abstract

Introduction: Left atrial posterior wall (LAPW) isolation is associated with favorable outcomes for catheter ablation of persistent atrial fibrillation (PEAF). Techniques for LAPW isolation include ablation at the periphery with or without high density ablation within the LAPW. The proportion of LA isolated by the lesion set also varies greatly. The optimal technique to achieve LAPW isolation is not clear. Objective: To assess impact of ablation lesion density within and dimensions of the LAPW isolation region on arrhythmia recurrence in catheter ablation of PEAF. Methods: LAPW lesion density and surface area relative to total LA surface area were calculated using electroanatomic maps of 110 consecutive patients undergoing LAPW isolation for PEAF (CARTO 3, Biosense Webster, Inc.). LAPW isolation was performed at the discretion of 5 experienced operators after voltage mapping. LAPW PV entrance and exit block were confirmed. Arrhythmia recurrence at two years was assessed by Kaplan-Meier analysis. Results: LAPW lesion density ranged from 0% - 99%. The proportion of LA surface area isolated ranged from 35% - 75%. There was no significant difference in arrhythmia-free survival stratified by median LAPW ablation density (31% vs. 27%, p=0.8) or median proportion of electrically-isolated LA surface area (31% vs. 27%, p=0.8%). Voltage map-guided LAPW isolation did not significantly decrease arrhythmia recurrence (29% vs. 28%, p=1). Conclusion: Neither the density of ablation within nor the dimensions of the LAPW isolated region predicted arrhythmia-free survival for catheter ablation of PEAF. Voltage map-guided LAPW isolation resulted in similar ablation efficacy regardless of LA scar burden.