Backgrounds We have previously reported that left lateral isthmus ablation(LLI) hardly achieves bidirectional block with a risk of hemopericardium without beneficial clinical outcome in patients with atrial fibrillation (AF). We hypothesized that left atrial (LA) anterior wall linear ablation (LAAW) produce better clinical outcome as compared the effects of with classical LLI.
Methods and Results We compared the clinical outcomes of LAAW and LLI in 104 patients with persistent AF (PeAF: 81.6% male, 61.2±10.3 years old). After bi-antral ablation with electrical isolation of pulmonary veins, cavotricuspid isthmus block, LA roof linear ablation, LAAW (n=55) or LLI (n=59) were performed. LAAW was performed by linear ablations from mitral annulus 12 O’clock to both antral ablation lines along anteroseptum and anterolateral wall based on LA appendage utilizing open irrigation tip catheter. Bidirectional block was test by pacing from LA appendage and right atrial pacing. Results: 1. There was no significant difference in age and ejection fraction. However, LA size was slightly bigger in LAAW than LLI (47.7±5.9 mm vs. 43.9±5.7 mm, p=0.015). 2. In contrast the length of linear ablation was longer in LAAW (37.9±3.4 mm vs. 26.6±3.2 mm, p<0.0001), the achievement of bidrectional block was higher in LAAW (60.0% vs. 32.4%, p=0.013) as compared with LLI. Mean duration of LAAW and LLI (including inside coronary sinus ablation) were 19.3±2.9 min and 18.2±3.7 min (p=0.086), and total ablation duration were 85.7±38.4 min and 101.9±62.0 min (p=0.074), respectively. 3. There was a case of transient ischemic attack in LAAW group and 2 cases of pericardial effusion in LLI. During 23.3±7.4 months follow-up, the recurrence rate of AF were 21.8% in LAAW and 38.9% in LLI (p=0.024).
Conclusion Linear ablations along anteroseptum and LA appendage base results in better clinical outcome with higher rate of bidirectional conduction block as compared with classical LLI in patients with PeAF.
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