TY - JOUR
T1 - Impact of anteroinferior transseptal puncture on creation of a complete block at the mitral isthmus in patients with atrial fibrillation
AU - Okubo, Kenji
AU - Kuwahara, Taishi
AU - Takigawa, Masateru
AU - Tanaka, Yasuaki
AU - Nakajima, Jun
AU - Watari, Yuji
AU - Nakashima, Emiko
AU - Yamao, Kazuya
AU - Sagawa, Yuichiro
AU - Takagi, Katsumasa
AU - Fujino, Tadashi
AU - Tsutsui, Hiroyuki
AU - Takahashi, Atsushi
N1 - Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Purpose: Achieving complete mitral isthmus (MI) conduction block for atrial fibrillation (AF) ablation remains challenging. We hypothesized that transseptal puncture (TSP) at the anteroinferior aspect of the atrial septum (anteroinferior TSP) could shorten the distance to the MI and improve catheter contact and stability, enabling complete MI block. This study investigated the efficacy of anteroinferior TSP for MI ablation in AF patients. Methods: Three hundred and twenty consecutive patients (mean age: 62 ± 9 years, 84 % male) with persistent AF undergoing AF ablation, including MI ablation, were enrolled. MI ablation was performed through the conventional (posterior) TSP site (group C, n = 170) or the anteroinferior TSP site (group A, n = 150). Results: Left atrial diameter (LAD) enlargement was greater in group A than in group C (45.8 ± 5.3 mm vs. 44.1 ± 5.0 mm, p = 0.002). Complete MI block at the initial session was significantly higher in group A than in group C (141/150 [94 %] vs. 144/170 [85 %], p = 0.011). At the repeat session for AF recurrence, the rate of persistent complete MI block was significantly higher in group A than in group C (36/48 [75 %] vs. 28/67 [42 %], p < 0.001). LAD (p = 0.011) and left ventricular diastolic dimension (p = 0.037) were significant predictors of failed MI block, while anteroinferior TSP was significantly associated with successful MI block (p < 0.001). Conclusion: Anteroinferior TSP could improve the initial success rate and long-term persistence of complete MI block for AF ablation.
AB - Purpose: Achieving complete mitral isthmus (MI) conduction block for atrial fibrillation (AF) ablation remains challenging. We hypothesized that transseptal puncture (TSP) at the anteroinferior aspect of the atrial septum (anteroinferior TSP) could shorten the distance to the MI and improve catheter contact and stability, enabling complete MI block. This study investigated the efficacy of anteroinferior TSP for MI ablation in AF patients. Methods: Three hundred and twenty consecutive patients (mean age: 62 ± 9 years, 84 % male) with persistent AF undergoing AF ablation, including MI ablation, were enrolled. MI ablation was performed through the conventional (posterior) TSP site (group C, n = 170) or the anteroinferior TSP site (group A, n = 150). Results: Left atrial diameter (LAD) enlargement was greater in group A than in group C (45.8 ± 5.3 mm vs. 44.1 ± 5.0 mm, p = 0.002). Complete MI block at the initial session was significantly higher in group A than in group C (141/150 [94 %] vs. 144/170 [85 %], p = 0.011). At the repeat session for AF recurrence, the rate of persistent complete MI block was significantly higher in group A than in group C (36/48 [75 %] vs. 28/67 [42 %], p < 0.001). LAD (p = 0.011) and left ventricular diastolic dimension (p = 0.037) were significant predictors of failed MI block, while anteroinferior TSP was significantly associated with successful MI block (p < 0.001). Conclusion: Anteroinferior TSP could improve the initial success rate and long-term persistence of complete MI block for AF ablation.
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U2 - 10.1007/s10840-016-0203-9
DO - 10.1007/s10840-016-0203-9
M3 - Article
C2 - 27812768
AN - SCOPUS:84994351092
SN - 1383-875X
VL - 48
SP - 317
EP - 325
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 3
ER -