PURPOSE: Achieving complete mitral isthmus (MI) conduction block for atrial fibrillation (AF) ablation remains challenging. We hypothesized that transseptal puncture (TSP) at the anteroinferior aspect of the atrial septum (anteroinferior TSP) could shorten the distance to the MI and improve catheter contact and stability, enabling complete MI block. This study investigated the efficacy of anteroinferior TSP for MI ablation in AF patients. METHODS: Three hundred and twenty consecutive patients (mean age: 62 ± 9 years, 84 % male) with persistent AF undergoing AF ablation, including MI ablation, were enrolled. MI ablation was performed through the conventional (posterior) TSP site (group C, n = 170) or the anteroinferior TSP site (group A, n = 150). RESULTS: Left atrial diameter (LAD) enlargement was greater in group A than in group C (45.8 ± 5.3 mm vs. 44.1 ± 5.0 mm, p = 0.002). Complete MI block at the initial session was significantly higher in group A than in group C (141/150 [94 %] vs. 144/170 [85 %], p = 0.011). At the repeat session for AF recurrence, the rate of persistent complete MI block was significantly higher in group A than in group C (36/48 [75 %] vs. 28/67 [42 %], p < 0.001). LAD (p = 0.011) and left ventricular diastolic dimension (p = 0.037) were significant predictors of failed MI block, while anteroinferior TSP was significantly associated with successful MI block (p < 0.001). CONCLUSION: Anteroinferior TSP could improve the initial success rate and long-term persistence of complete MI block for AF ablation.
PURPOSE: Achieving complete mitral isthmus (MI) conduction block for atrial fibrillation (AF) ablation remains challenging. We hypothesized that transseptal puncture (TSP) at the anteroinferior aspect of the atrial septum (anteroinferior TSP) could shorten the distance to the MI and improve catheter contact and stability, enabling complete MI block. This study investigated the efficacy of anteroinferior TSP for MI ablation in AFpatients. METHODS: Three hundred and twenty consecutive patients (mean age: 62 ± 9 years, 84 % male) with persistent AF undergoing AF ablation, including MI ablation, were enrolled. MI ablation was performed through the conventional (posterior) TSP site (group C, n = 170) or the anteroinferior TSP site (group A, n = 150). RESULTS: Left atrial diameter (LAD) enlargement was greater in group A than in group C (45.8 ± 5.3 mm vs. 44.1 ± 5.0 mm, p = 0.002). Complete MI block at the initial session was significantly higher in group A than in group C (141/150 [94 %] vs. 144/170 [85 %], p = 0.011). At the repeat session for AF recurrence, the rate of persistent complete MI block was significantly higher in group A than in group C (36/48 [75 %] vs. 28/67 [42 %], p < 0.001). LAD (p = 0.011) and left ventricular diastolic dimension (p = 0.037) were significant predictors of failed MI block, while anteroinferior TSP was significantly associated with successful MI block (p < 0.001). CONCLUSION: Anteroinferior TSP could improve the initial success rate and long-term persistence of complete MI block for AF ablation.
Authors: Tobias Reichlin; Sven Knecht; Christopher Lane; Michael Kühne; Eyal Nof; Nagesh Chopra; Thomas M Tadros; Vivek Y Reddy; Beat Schaer; Roy M John; Stefan Osswald; William G Stevenson; Christian Sticherling; Gregory F Michaud Journal: Heart Rhythm Date: 2013-10-28 Impact factor: 6.343
Authors: Andrea Natale; Vivek Y Reddy; George Monir; David J Wilber; Bruce D Lindsay; H Thomas McElderry; Charan Kantipudi; Moussa C Mansour; Daniel P Melby; Douglas L Packer; Hiroshi Nakagawa; Baohui Zhang; Robert B Stagg; Lee Ming Boo; Francis E Marchlinski Journal: J Am Coll Cardiol Date: 2014-08-19 Impact factor: 24.094
Authors: Sébastien Knecht; Mélèze Hocini; Matthew Wright; Nicolas Lellouche; Mark D O'Neill; Seiichiro Matsuo; Isabelle Nault; Vijay S Chauhan; Kevin J Makati; Michela Bevilacqua; Kang-Teng Lim; Frederic Sacher; Antoine Deplagne; Nicolas Derval; Pierre Bordachar; Pierre Jaïs; Jacques Clémenty; Michel Haïssaguerre Journal: Eur Heart J Date: 2008-07-08 Impact factor: 29.983
Authors: Christopher P Ruisi; Neil Brysiewicz; Jeremy D Asnes; Lissa Sugeng; Mark Marieb; Jude Clancy; Joseph G Akar Journal: Pacing Clin Electrophysiol Date: 2013-01-10 Impact factor: 1.976
Authors: Fiorenzo Gaita; Domenico Caponi; Marco Scaglione; Antonio Montefusco; Antonella Corleto; Fernando Di Monte; Daniele Coin; Paolo Di Donna; Carla Giustetto Journal: Circ Arrhythm Electrophysiol Date: 2008-10