Endocardial-epicardial left atrial posterior wall asynchrony during human persistent AF is characterized by greater epicardial voltages, activation gradients, and conduction block.
Observational
The left atrial posterior wall exhibits dynamic 3-dimensional arrhythmogenicity during persistent AF, highlighting the potential importance of the epicardial layer for future ablation therapies.
Endocardial-epicardial LAPW asynchrony may be observed during human persistent AF and is characterized by: (1) greater epicardial compared with endocardial bipolar voltages, (2) more frequent epicardial-to-endocardial activation gradients during AF, and (3) conduction block commonly seen between the epicardial and endocardial surfaces during AF. Although the study was predominantly descriptive in nature, the observations suggest a dynamic 3-dimensional arrhythmogenicity of the LAPW and the potential importance of the epicardial layer, with implications for ablation therapies. Future prospective studies are required to determine the significance of these findings to clinical ablation outcomes.
Wong et al. (2026) conducted an observational in Persistent atrial fibrillation. Endocardial-epicardial left atrial posterior wall asynchrony during human persistent AF is characterized by greater epicardial voltages, activation gradients, and conduction block.