Left Atrial Roof Line Ablation

7 9 20 conversely the exclusion of the la posterior wall has no effect on the incidence of af recurrences after circumferential pv ablation in a randomized trial of 120 patients 60 in paf.

Left atrial roof line ablation.

It has been suggested that ablation lines along the roof of the la and mitral isthmus may improve clinical outcomes in paf. 13 finally a randomized prospective trial comparing segmental pv isolation and circumferential pv ablation plus linear ablation at the la roof and mi showed that significantly. Left atrial tachycardias ats most commonly occur after catheter or surgical ablation of atrial fibrillation and in patients with atrial myopathies. Background isolation of the pulmonary veins pvs for the treatment of atrial fibrillation af is often supplemented with linear lesions within the left atrium la.

Atrial fibrillation ablation is a procedure used to treat an irregular heart rhythm arrhythmia that starts in the heart s upper chambers atria. Roofline ablation was performed at the most cranial part of the left atrium la with complete conduction block demonstrated during la appendage pacing by the online mapping of continuous double potential and an activation detour propagating around the pvs to activate caudocranially the posterior wall of the la. They described the phenomenon of intra atrial conduction block in a subset of patients undergoing ablation for left lateral accessory pathways. Addition of linear ablation lesions principally in the atrial roof between the left and right superior pulmonary veins and mitral isthmus between the left inferior pulmonary vein and the mitral annulus led to improved success rates especially in patients with paroxysmal af and coexistent la enlargement and in patients with persistent af.

A left atrial isthmus was first described by luria et al. However there are conflicting data on the effects of creating a roof line rl joining the superior pvs in paroxysmal atrial fibrillation paf. If there continues to be afib activity the doctor will ablate the next area in the sequence. Pre existing scar in the left atrium la can result in complex circuits sometimes with narrow channels that can be detected with high resolution mapping.

That is doctors may make a lesion line along the roof of the left atrium and then pace or use a mapping catheter to determine whether conduction has been stopped. It is sometimes called sequential ablation because the additional ablation lines are performed in a specified order. Of the several proposed linear lesions only mitral isthmus and roof line ablation remain commonly performed as an adjunct to pulmonary vein isolation in the treatment of atrial fibrillation 2 3.