Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-175 - Combined Isolation Of Left Atrial Posterior Wall And Pulmonary Veins In Persistent Atrial Fibrillation Is Feasible And Safe But Arrhythmia-free Reconduction Is Frequent At Six Months Relook (ID 1140)


Background: Posterior wall isolation (PWI) to improve outcomes in AF ablation is disputed due to lack of proven feasibility, efficacy and risk of complications including esophagus injury.
Objective: First, to determine the feasibility of combined PVI/PWI for persistent AF in terms of procedural parameters and esophageal injury. Second, by a mandated relook determine durability and relate gaps to ablation indices and to AF recurrence on implantable loop recorder (ILR).
Methods: Twenty-four patients (time in AF: 9.8 ± 6.6 months) underwent PVI/PWI with esophagus temperature monitoring, ILR implant and next-day esophagoscopy. All had a relook procedure at six months. Lesion sets were analyzed post hoc with the Ablation Index algorithm (AI). For each ablation a dataset of AI, esophagus temperature and reconduction vs. no reconduction of the corresponding segment at relook was analyzed.
Results: Esophagoscopy revealed a small erythema in two patients (8,3%) that did not correlate with temperatures or AI of adjacent segments of the left atrium. No esophagus fistulas. PVI/PWI was obtained in 100% where 33% required ablation in the “center - right carina zone”. The costs of adding PWI to PVI were minor. At relook 71% of the PVI/PWI lesion sets had at least one conduction gap while cumulated AF recurrence on ILR was 25%. Conduction gaps occurred in (23%) of PWI segments vs. 5% of PVI segments. Index procedure AI did not predict reconduction at the relook procedure in any segment.
Conclusion: Combined PVI/PWI was safe compared to earlier reports and was achieved with minor added procedural costs. Though the lesion set was fully intact in only 29% after six months the AF recurrence rate appeared relatively low.