Arrhythmias & electrophysiology
Impact of Posterior Wall Isolation During AF Ablation on the Incidence of Left Atrial Flutter
Authors' conclusion
The incidence of LAMT following PVI + PWI is higher than with PVI alone but significantly lower than with more extensive atrial substrate modification.
Study context
- Population
- Consecutive patients undergoing catheter ablation for AF or LAMT post-AF ablation, 2008–2022, minimum follow-up 12 months
- Participants
- 4,783 patients5,619 AF ablation procedures
- Exposure
- Pulmonary vein isolation (PVI) alone vs PVI + posterior wall isolation (PWI) vs PVI + PWI + linear and complex electrogram ablation (LCEA)
- Outcome
- Incidence of left atrial macro-re-entrant tachycardia (LAMT)
- Follow-up
- Mean 6.4 ± 3.8 years
Methodological detailsmulticentre, 4 electrophysiology centres, consecutive patients
- Multicentre
- 4 electrophysiology centres
- Consecutive patients
Main finding
As reported in the abstract
Incidence of LAMT
PVI + PWI vs PVI alone: P < 0.0001 · PVI + PWI + LCEA vs PVI + PWI: P = 0.019
Observational data: associations, not effects.
Further findings
LAMT due to conduction gaps in previous ablation lines — PVI + PWI vs PVI alone
P = 0.386
| Outcome | P value |
|---|---|
| LAMT due to conduction gaps in previous ablation linesPVI + PWI + LCEA vs PVI alone | P < 0.005 |
LAMT circuit types (% of patients)
- Perimitral
- 52.8%
- Roof-dependent
- 27.1%
- PV gap-related
- 17.3%
- Anterior
- 8.9%
- Multiple circuits
- 16.4%
Original publication
Impact of Posterior Wall Isolation During AF Ablation on the Incidence of Left Atrial Flutter. JACC Clin Electrophysiol. Published 16 May 2024. doi:10.
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