Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions : the ALINE study
Aims: Achieving block across linear lesions is challenging. We prospectively evaluated radiofrequency (RF) linear ablation at the roof and mitral isthmus (MI) using point-by-point contiguous and optimized RF lesions.
Methods and results: Forty-one consecutive patients with symptomatic persistent AF underwent stepwise contact force (CF)-guided catheter ablation during ongoing AF. A single linear set of RF lesions was delivered at the roof and posterior MI according to the 'Atrial LINEar' (ALINE) criteria, i.e. point-by-point RF delivery (up to 35 W) respecting strict criteria of contiguity (inter-lesion distance ≤ 6 mm) and indirect lesion depth assessment (ablation index ≥550). We assessed the incidence of bidirectional block across both lines only after restoration of sinus rhythm. After a median RF time of 7 min [interquartile range (IQR) 5-9], first-pass block across roof lines was observed in 38 of 41 (93%) patients. Final bidirectional roof block was achieved in 40 of 41 (98%) patients. First-pass block was observed in 8 of 35 (23%) MI lines, after a median RF time of 8 min (IQR 7-12). Additional endo- and epicardial (54% of patients) RF applications resulted in final bidirectional MI block in 28 of 35 (80%) patients. During a median follow-up of 396 (IQR 310-442) days, 12 patients underwent repeat procedures, with conduction recovery in 4 of 12 and 5 of 10 previously blocked roof lines and MI lines, respectively. No complications occurred.
Conclusion: Anatomical linear ablation using contiguous and optimized RF lesions results in a high rate of first-pass block at the roof but not at the MI. Due to its complex 3D architecture, the MI frequently requires additional endo- and epicardial RF lesions to be blocked.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
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| Enthalten in: |
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology - 20(2018), FI_3 vom: 01. Nov., Seite f401-f409 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wolf, Michael [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 29.07.2019 Date Revised 29.07.2019 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/europace/eux350 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM279875266 |
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| 100 | 1 | |a Wolf, Michael |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions |b the ALINE study |
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| 500 | |a Date Revised 29.07.2019 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Aims: Achieving block across linear lesions is challenging. We prospectively evaluated radiofrequency (RF) linear ablation at the roof and mitral isthmus (MI) using point-by-point contiguous and optimized RF lesions | ||
| 520 | |a Methods and results: Forty-one consecutive patients with symptomatic persistent AF underwent stepwise contact force (CF)-guided catheter ablation during ongoing AF. A single linear set of RF lesions was delivered at the roof and posterior MI according to the 'Atrial LINEar' (ALINE) criteria, i.e. point-by-point RF delivery (up to 35 W) respecting strict criteria of contiguity (inter-lesion distance ≤ 6 mm) and indirect lesion depth assessment (ablation index ≥550). We assessed the incidence of bidirectional block across both lines only after restoration of sinus rhythm. After a median RF time of 7 min [interquartile range (IQR) 5-9], first-pass block across roof lines was observed in 38 of 41 (93%) patients. Final bidirectional roof block was achieved in 40 of 41 (98%) patients. First-pass block was observed in 8 of 35 (23%) MI lines, after a median RF time of 8 min (IQR 7-12). Additional endo- and epicardial (54% of patients) RF applications resulted in final bidirectional MI block in 28 of 35 (80%) patients. During a median follow-up of 396 (IQR 310-442) days, 12 patients underwent repeat procedures, with conduction recovery in 4 of 12 and 5 of 10 previously blocked roof lines and MI lines, respectively. No complications occurred | ||
| 520 | |a Conclusion: Anatomical linear ablation using contiguous and optimized RF lesions results in a high rate of first-pass block at the roof but not at the MI. Due to its complex 3D architecture, the MI frequently requires additional endo- and epicardial RF lesions to be blocked | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a El Haddad, Milad |e verfasserin |4 aut | |
| 700 | 1 | |a Fedida, Joël |e verfasserin |4 aut | |
| 700 | 1 | |a Taghji, Philippe |e verfasserin |4 aut | |
| 700 | 1 | |a Van Beeumen, Katarina |e verfasserin |4 aut | |
| 700 | 1 | |a Strisciuglio, Teresa |e verfasserin |4 aut | |
| 700 | 1 | |a De Pooter, Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Lepièce, Caroline |e verfasserin |4 aut | |
| 700 | 1 | |a Vandekerckhove, Yves |e verfasserin |4 aut | |
| 700 | 1 | |a Tavernier, René |e verfasserin |4 aut | |
| 700 | 1 | |a Duytschaever, Mattias |e verfasserin |4 aut | |
| 700 | 1 | |a Knecht, Sébastien |e verfasserin |4 aut | |
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