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- Title
Complete Isolation Of The Left Atrial Posterior Wall (Box Lesion) To Treat Longstanding Persistent Atrial Fibrillation.
- Authors
Saad, Eduardo B.; Slater, Charles
- Abstract
Introduction: The left atrial posterior wall has been shown to play na important role in AF pathophysiology. Objective: Evaluate the efficacy of an ablation strategy designed to completely isolate the LA posterior wall, on top of PV isolation. Methods and Results: 25 pts (72% male age 65 ± 12 years) undergoing AF ablation for persistent or long term persistent AF. Mean AF duration was 11 ± 3 months and mean LA diameter was 4.8 ± 0.4 mm. After complete PVI, a "Roof Line" was created between the top of each contralateral set of lesions and a "floor line" closed the posterior wall in a "Box" fashion, connecting the bottom of each set of contralateral lesions. After an average follow-up of 16 ± 2 months, 20 patients (80%) were free of any atrial arrhythmia recurrences (18 of whom off drugs). Five patients (20%) had sustained atypical flutter and required a new ablation procedure. All these patients had mitral isthmus dependent flutters and no electrical conduction in the PVs or posterior wall were detected. Conclusions: Complete LA posterior wall isolation on top of PV is associated with good outcomes in patients with persistent and long-standing persistent AF when performed using meticulous bidirectional isolation criteria and adenosine infusion. Recurrences occur predominately as perimitral flutter, without gaps in the posterior wall.
- Subjects
ATRIAL fibrillation treatment; ATRIAL arrhythmias; ADENOSINES; INFUSION therapy; PULMONARY veins
- Publication
JAFIB: Journal of Atrial Fibrillation, 2014, Vol 7, Issue 4, p6
- ISSN
1941-6911
- Publication type
Article