5 Conclusion
Areas of high voltage (i.e., ≥ 2.64 mV) and thick LA walls (i.e., ≥ 2.04 mm) under the ablation line, and a long roof line ≥ 43.4 mm were shown to be determinants of conduction through gaps in the ablation line after first-pass LAPWI. A modified AI ≥ 199 AU/mV may predict durable LAPWI.
References
1. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace . 2012; 14 (4): 528- 606.
2. Bai R, Di Biase L, Mohanty P, et al. Proven isolation of the pulmonary vein antrum with or without left atrial posterior wall isolation in patients with persistent atrial fibrillation. Heart Rhythm . 2016; 13 (1): 132- 140.
3. Lee JM, Shim J, Park J, et al. The electrical isolation of the left atrial posterior wall in catheter ablation of persistent atrial fibrillation. JACC Clin Electrophysiol. 2019; 5 (11): 1253- 1261.
4. Sutter JS, Lokhnygina Y, Daubert JP, et al. Safety and efficacy outcomes of left atrial posterior wall isolation compared to pulmonary vein isolation and pulmonary vein isolation with linear ablation for the treatment of persistent atrial fibrillation. Am Heart J . 2020;220 : 89- 96.
5. Winkle RA, Mohanty S, Patrawala RA, et al. Low complication rates using high power (45-50 W) for short duration for atrial fibrillation ablations. Heart Rhythm. 2019; 16 (2): 165- 169.
6. Okamatsu H, Koyama J, Sakai Y, et al. High-power application is associated with shorter procedure time and higher rate of first-pass pulmonary vein isolation in ablation index-guided atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2019; 30 (12): 2751- 2758.
7. Phlips T, Taghji P, El Haddad M, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ’CLOSE’-protocol. Europace. 2018;20 (FI_3): f419- f427.
8. Wakamatsu Y, Nagashima K, Watanabe I, et al. The modified ablation index: a novel determinant of acute pulmonary vein reconnections after pulmonary vein isolation. J Interv Card Electrophysiol . 2019;55 (3): 277- 285.
9. Nagashima K, Watanabe I, Okumura Y, et al. High-voltage zones within the pulmonary vein antra: major determinants of acute pulmonary vein reconnections after atrial fibrillation ablation. J Interv Card Electrophysiol . 2017; 49 (2): 137- 145.
10. Takahashi K, Okumura Y, Watanabe I, et al. Relation between left atrial wall thickness in patients with atrial fibrillation and intracardiac electrogram characteristics and ATP-provoked dormant pulmonary vein conduction. J Cardiovasc Electrophysiol . 2015;26 (6): 597- 605.
11. Iso K, Okumura Y, Watanabe I, et al. Wall thickness of the pulmonary vein-left atrial junction rather than electrical information as the major determinant of dormant conduction after contact force-guided pulmonary vein isolation. J Interv Card Electrophysiol . 2016;46 (3): 325- 333.
12. Nagashima K, Okumura Y, Watanabe I, et al. Association between epicardial adipose tissue volumes on 3-dimensional reconstructed CT images and recurrence of atrial fibrillation after catheter ablation.Circ J . 2011; 75 (11): 2559- 2565.
13. Nagashima K, Okumura Y, Watanabe I, et al. Does location of epicardial adipose tissue correspond to endocardial high dominant frequency or complex fractionated atrial electrogram sites during atrial fibrillation? Circ Arrhythm Electrophysiol. 2012; 5 (4): 676- 683.
14. McLellan AJA, Prabhu S, Voskoboinik A, et al. Isolation of the posterior left atrium for patients with persistent atrial fibrillation: routine adenosine challenge for dormant posterior left atrial conduction improves long-term outcome. Europace. 2017; 19 (12): 1958- 1966.
15. Thiyagarajah A, Kadhim K, Lau DH, et al. feasibility, safety, and efficacy of posterior wall isolation during atrial fibrillation ablation. Circ Arrhythm Electrophysiol. 2019; 12 (8): e007005.
16. Ho SY, Sanchez-Quintana D, Cabrera JA, Anderson RH. Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. Journal of cardiovascular electrophysiology . 1999;10 (11): 1525- 1533.
17. Markides V, Schilling RJ, Ho SY, Chow AW, Davies DW, Peters NS. Characterization of left atrial activation in the intact human heart.Circulation. 2003; 107 (5): 733- 739.
18. Wolf M, El Haddad M, Fedida J, et al. Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions: the ALINE study. Europace. 2018; 20 (FI_3): f401- f409.
19. Arujuna A, Karim R, Caulfield D, et al. Acute pulmonary vein isolation is achieved by a combination of reversible and irreversible atrial injury after catheter ablation: evidence from magnetic resonance imaging. Circ Arrhythm Electrophysiol . 2012; 5 (4): 691- 700.