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Impact of anteroinferior transseptal puncture on creation of a complete block at the mitral isthmus in patients with atrial fibrillation

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Abstract

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.

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Authors and Affiliations

  1. Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan

    Kenji Okubo, Taishi Kuwahara, Masateru Takigawa, Yasuaki Tanaka, Jun Nakajima, Yuji Watari, Emiko Nakashima, Kazuya Yamao, Yuichiro Sagawa, Katsumasa Takagi, Tadashi Fujino & Atsushi Takahashi

  2. Department of Cardiovascular Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan

    Kenji Okubo & Hiroyuki Tsutsui

Authors
  1. Kenji Okubo
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  2. Taishi Kuwahara
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  3. Masateru Takigawa
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  4. Yasuaki Tanaka
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  5. Jun Nakajima
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  6. Yuji Watari
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  7. Emiko Nakashima
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  8. Kazuya Yamao
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  10. Katsumasa Takagi
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  11. Tadashi Fujino
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  13. Atsushi Takahashi
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Corresponding author

Correspondence to Kenji Okubo.

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The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Okubo, K., Kuwahara, T., Takigawa, M. et al. Impact of anteroinferior transseptal puncture on creation of a complete block at the mitral isthmus in patients with atrial fibrillation. J Interv Card Electrophysiol 48, 317–325 (2017). https://doi.org/10.1007/s10840-016-0203-9

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  • DOI: https://doi.org/10.1007/s10840-016-0203-9

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