Why the study?
Complete isolation of the left atrial posterior wall is challenging due to overlapping epicardial conduction, prompting investigation into whether transmural block completion relates to ablation site peak frequency.
Does peak frequency-guided ablation improve left atrial roof and floor line success rates compared to conventional ablation in patients undergoing initial left atrial posterior wall isolation?
Does peak frequency-guided ablation improve left atrial roof and floor line success rates compared to conventional ablation in patients undergoing initial left atrial posterior wall isolation?
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Using a peak frequency map to guide left atrial posterior wall isolation improves roof line block success rates while reducing radiofrequency applications and procedural time.
INTRODUCTION: Complete isolation of the left atrial posterior wall (LAPW) is challenging owing to overlapping epicardial conduction. Peak frequency (PF) is a novel parameter that focuses on near- and far-field electrogram components. In this study, we aimed to determine whether transmural block completion is related to the ablation site PF. METHODS: We analyzed 44 consecutive patients undergoing initial LAPW isolation (LAPWI) between June 2023 and February 2024. Pre-LAPWI and PF maps were obtained using an HD-Grid catheter. In 17 of the 44 patients (Group-1), LAPWI was performed conventionally. In the remaining 27 patients (Group-2), PF-guided LAPWI was applied based on Group-1 results. RESULTS: In Group-1, the left atrial (LA) roof and floor line success rates were 58.8% and 76.5%, respectively. The average PF value in the roof lines of patients with a completed block line was significantly higher than that of the remaining patients (286.6 ± 29.3 Hz vs. 236.1 ± 40.9 Hz, p = .012), but the floor lines were similar. In Group-2, relatively high PF values were targeted to achieve complete block of the LA roof and floor lines, following the results obtained in Group-1. The LA roof line success rates (92.6% vs. 58.8%, p = .007), total number of radiofrequency (RF) applications (22.7 ± 5.6 vs. 27.6 ± 8.5, p = .03), and procedural time (32.6 ± 18.3 vs. 47.9 ± 25.6 min, p = .03) differed between Group-1 and Group-2. CONCLUSION: Using a PF map for determining the optimal ablation line for LAPWI by RF catheter ablation is feasible.
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Yamagami et al. (2024) studied this question.
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