Persistency of left atrial linear lesions after radiofrequency catheter ablation for atrial fibrillation: Data from an invasive follow‐up electrophysiology study

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Although pulmonary vein isolation (PVI) has become a mainstay of catheter ablation (CA) for atrial fibrillation (AF), the clinical success of the procedure seems to be lower in patients with nonparoxysmal AF and/or a pronounced left atrium (LA) enlargement.1 Different strategies for additional AF substrate modification on top of PVI have been developed, including various combinations of LA linear lesions.1
Clinical effectiveness of the combination of two standard LA linear lesions—the roof line (RL) and mitral isthmus line (MIL) is based on LA compartmentalization, denervation, non‐PV triggers elimination, and prevention of post‐PVI macro‐reentrant atrial tachycardias (ATs).1 Only complete conduction block across the lines can provide arrhythmia suppression, avoiding the proarrhythmic effect of ablation resulting in the scar‐related ATs.7 Sometimes, this task is challenging, leading to prolongation of the procedure time and radiation exposure, with increased risk of serious complications.1 Hence, the acute success rate of the LA linear ablation is limited to 70–80%.8
Data on the durability of LA linear lesions after a primary successful ablation are very scarce. Few studies reported disappointingly high late reconnection rates between 62% and 90% of the LA lines in patients subjected to repeated CA for clinical reasons.5 Since patients with AF relapse after previous ablation were the only ones studied, these data should be interpreted with caution due to possible selection bias, while the rates of late reconduction over the LA linear lesions irrespective of clinical outcome after a first‐ever CA remain largely unknown.
The objectives of this study were to determine the rate and the sites of intracardiac electrical reconnections using the invasive follow‐up electrophysiology (EP) study at 3 months after irrigated radiofrequency CA (RFCA) of the RL and MIL in a cohort of consecutive patients who underwent this set of linear lesions on top of PVI during their first‐ever AF ablation procedure.
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