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Cardiovascular Disease |

Extended Posterior Left Atrial Substrate Ablation for Advanced Atrial Fibrillation

M. Clive Robinson, MD; Murali Chiravuri, MD; Robert Winslow, MD; Craig McPherson, MD; Murthy Chamarthy, MD
Author and Funding Information

Northeast Medical Group, Bridgeport, CT


Chest. 2013;144(4_MeetingAbstracts):162A. doi:10.1378/chest.1704612
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Abstract

SESSION TITLE: Cardiovascular Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Successful radio-frequency (RF) ablation for advanced atrial fibrillation (AF) usually requires energy delivery to the posterior left atrium (LA) with its well-known challenges. The typically utilized single linear and spot lesions are often associated with inadequate substrate exclusion, are prone to reconnection, and carry safety concerns. To address these issues, we describe a method, including early results of maximized epicardial endoscopic posterior LA debulking as part of the Hybrid Convergent (CV) Ablation procedure.

METHODS: Pericardial access was by an endoscopic approach through the diaphragm. Multiple adjoining 3x1 cm epicardial RF ablation lines were made using the Numeris Coagulation Device, usually in two rows, to continuously span the transverse and vertical dimensions of the posterior LA. Once completed, endocardial mapping with ablation was performed to complete pulmonary vein isolation (PVI), place a cavo-tricuspid line (C-TL) and to terminate remaining arrhythmias where applicable. Follow up protocol include two 2-week continuous rhythm monitoring intervals.

RESULTS: There were 42 patients, including 24 with persistent and 18 with long-standing persistent AF, all on anti-arrhythmic drugs (AAD). Mean duration of AF was 5.2 years (SD 4.3). Mean LA dimensions (by CT scan) were 7.1 x 6.7 cm and mean LA volume 116.8 cc (68-190cc). Endocardial mapping showed electrical quiescence of the posterior LA that extinguished AF mechanisms, effected conduction block across the LA roof, PVI and CTL block. Mean follow up was 11 months. Hospital stay was 2.9 days. Of 35 patients beyond the blanking period: 31 are in SR (89% ), 23 of 31 in sinus rhythm off AADs (74%), 8 of 31 in sinus rhythm on AADs of which 2 required redo targeted flutter ablations. 4 of 35 have significant residual AF burden. There were no deaths, 2 late tamponades, and 1 TIA. None experienced esophageal symptoms.

CONCLUSIONS: Early results indicate effectiveness in comprehensive debulking of left atrial mechanisms with reduced need for endocardial ablation by using a well-tolerated procedure with short hospital stay.

CLINICAL IMPLICATIONS: The method has substantial potential for ablation in a traditionally resistant group of advanced cases of AF.

DISCLOSURE: M. Clive Robinson: Consultant fee, speaker bureau, advisory committee, etc.: Consulting Fees/Honoraria Murali Chiravuri: Consultant fee, speaker bureau, advisory committee, etc.: Consulting Fees/Honoraria Robert Winslow: Consultant fee, speaker bureau, advisory committee, etc.: Speaker's Bureau The following authors have nothing to disclose: Craig McPherson, Murthy Chamarthy

No Product/Research Disclosure Information


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