AF Ablation by 4PV and LA Posterior Wall Isolation

概要

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Background: To simplify Af ablation procedure we have performed 4PV and LA posterior wall isolation using Ensite mapping since 2007. The aim of this study is to evaluate our procedure. Methods: Our procedure is individual 4PV isolations with encircling catheter following LA roof and bottom linear ablation with Ensite mapping. We used 8 mm tip conventional ablation catheters in 38 patients and irrigation catheters in 4 patients. Procedure endpoint is LA posterior wall isolation by LA posterior pacing at 3 volts using Ensite mapping. Results: In total 42 patients, Af ablation performed 51 procedure with 9 second sessions. 33 males and 9 females included this study (age: 36∼77 years). Their comobidities were HT (50%), dyslipidemia (26%), DM (19%), BTS (12%), SAS (5%), TIC (7%) and LA size showed 28∼46 mm diameter. Paroxysmal Af was 36 cases and Persistent Af was 6 cases. Procedure success rate is 95%. Complications included 1 pericardial effusion, 2 ST elevation by air embolism, 1 right phrenic nerve palsy, 1 cardiac tamponade and 1 cerebral embolism but all recovered. After procedure Af occurred in 19 patients (46%) in admission, however, follow-up (1∼35 months) recurrence rate were acceptable (27%). Electrophysiological test revealed LA-PV conduction in all second session cases. Conclusion: Our procedure has acceptable success rate and safety with advantage of clear endpoints at which LA posterior wall pacing fails LA anterior wall capture.