Cryoballoon ablation of the left atrial posterior wall reduces recurrence of persistent atrial fibrillation in patients with non‐paroxysmal atrial fibrillation

Figures

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  FIGURE 1. (Left panel) Fluoroscopic images during cryoballoon ablation of the (top) LA roof and (bottom) LAPW bottom (PA view). The cryoballoon is shifted gradually on the LA roof or the LAPW bottom from the left superior pulmonary vein to the right superior pulmonary vein or from the left inferior pulmonary vein to the right inferior pulmonary vein in an overlapping manner. (Right panel) Voltage map before and after the ablation procedure of a representative case in each therapeutic strategy. Upper panels show the case where we performed only PVI with a cryoballoon. The normal voltage area was left on the LAPW after the ablation. Middle panels show the case where we performed cryoballoon ablation of the LA roof without bottom line ablation. The normal voltage area left on the LAPW became smaller after the ablation. Lower panels show the case where we performed cryoballoon ablation of the LAPW in addition to PVI. The normal voltage area on the LAPW was confirmed before the ablation area became the scar area after the ablation, which indicates LAPW isolation. LA, left atrial; LAPW, left atrial posterior wall; PVI, pulmonary vein isolation

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  FIGURE 2. Kaplan–Meier curve of atrial arrhythmia recurrence after index ablation

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  FIGURE 3. Kaplan–Meier curves of (A) overall atrial arrhythmia recurrence, (B) AF recurrence, (C) persistent AF recurrence, (D) AT recurrence, and (E) persistent AF recurrence adjusted with several factors (AAD use, age, sex, body mass index, LAD, and AF duration) after the index ablation. The clinical outcomes for each recurrence pattern were compared among the three groups (Group A, patients who underwent only PVI; Group B, patients who underwent LA roof line ablation in addition to PVI; Group C, patients who underwent LA roof line and LAPW bottom line ablation in addition to PVI). The 12‐month Kaplan–Meier event‐free rate estimates were as follows: 65.7% versus 78.7% versus 79.1% (overall recurrence), 66.7% versus 82.4% versus 84.0% (AF recurrence), 79.8% versus 87.8% versus 91.9% (persistent AF recurrence), and 97.3% versus 93.4% versus 92.4% (AT recurrence). According to the Holm method, significant differences were found between patients who had undergone PVI only and those who had undergone LA roof line and LAPW bottom line ablation in terms of overall recurrence (p = .04), AF recurrence (p = .01), and persistent AF recurrence (p = .01). AADs, anti‐arrhythmic drugs; AT, atrial…

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  FIGURE 4. Percentage of durable lesions confirmed at the beginning of the redo ablation procedure. The analysis of PV durability was performed in 55 patients, including three patients with an LCPV who underwent redo ablation procedures. PV recurrence was confirmed in 6, 7, 15, and 18 patients at the LSPV, LIPV, RSPV, and RIPV, respectively. The durability of the LA roof line, LAPW bottom line, and CTI line was analyzed in patients who had obtained complete conduction block in the index ablation procedure (40 patients for the LA roof line, 29 patients for the LAPW bottom line, and 52 patients for the CTI line). CTI, cavotricuspid isthmus; LA, left atrial; LAPW, left atrial posterior wall; LCPV, left common pulmonary vein; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PV, pulmonary vein; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein