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Differences in the durability of left atrial posterior wall isolation based on the isolation process

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Abstract

Purpose

The best strategy for durable left atrial posterior wall isolation (PWI) after completion of pulmonary vein isolation (PVI) is not yet determined. This study aimed to examine the differences in the durability of PWI based on the isolation process and the predictors of the reconduction of PWI.

Methods

Among the 221 patients (mean age, 65 ± 11 years) with consecutive non-paroxysmal atrial fibrillation (AF) who completed PVI and PWI, 50 patients undergoing repeat AF ablation were enrolled and divided into the following groups based on how PWI was achieved at the initial procedure: by only the first line on the roof and floor line (group A), by additional gap ablation to the first line or second liner ablation next to the first line (group B), and by adjunct ablation inside the PW revealing the earliest activation (group C).

Results

Reconduction of PWI occurred in 24 of the 50 patients (48%). The durability of PWI in groups A, B, and C was 81% (17 of 21 patients), 75% (6 of 8 patients), and 14% (3 of 21 patients), respectively (p < 0.01). In a multivariate analysis, the ablation inside the PW for PWI was the independent predictor of the reconduction of PWI (p < 0.001).

Conclusion

PWI achieved by the ablation inside the PW resulted in a high rate of reconduction. It may be necessary to aim to achieve the PWI without ablating the inside of the PW to prevent reconduction.

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Authors and Affiliations

  1. Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan

    Shota Tamura, Kenji Shimeno, Kenichi Nakatsuji, Yusuke Hayashi, Yukio Abe & Takahiko Naruko

Authors
  1. Shota Tamura
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  2. Kenji Shimeno
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  3. Kenichi Nakatsuji
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  4. Yusuke Hayashi
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  5. Yukio Abe
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  6. Takahiko Naruko
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Contributions

Shota Tamura: drafting, data collection, and analysis; Kenji Shimeno: conception and design; Kenichi Nakatsuji: data collection and analysis; Yusuke Hayashi: data collection and analysis; Yukio Abe: revising critically for important intellectual content; Takahiko Naruko: final approval of the manuscript submitted.

Corresponding author

Correspondence to Kenji Shimeno.

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This retrospective study was approved by the institutional review board with a waiver of individual consent.

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This retrospective study was approved by the institutional review board with a waiver of individual consent.

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This retrospective study was approved by the institutional review board with a waiver of individual consent.

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The authors declare no competing interests.

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Tamura, S., Shimeno, K., Nakatsuji, K. et al. Differences in the durability of left atrial posterior wall isolation based on the isolation process. J Interv Card Electrophysiol 65, 45–51 (2022). https://doi.org/10.1007/s10840-021-01108-6

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  • DOI: https://doi.org/10.1007/s10840-021-01108-6

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