Left Atrial Roof Line Ablation

Pre existing scar in the left atrium la can result in complex circuits sometimes with narrow channels that can be detected with high resolution mapping.

Left atrial roof line ablation.

However there are conflicting data on the effects of creating a roof line rl joining the superior pvs in paroxysmal atrial fibrillation paf. Addition of linear ablation lesions principally in the atrial roof between the left and right superior pulmonary veins and mitral isthmus between the left inferior pulmonary vein and the mitral annulus led to improved success rates especially in patients with paroxysmal af and coexistent la enlargement and in patients with persistent af. If there continues to be afib activity the doctor will ablate the next area in the sequence. A left atrial isthmus was first described by luria et al.

It is sometimes called sequential ablation because the additional ablation lines are performed in a specified order. Roofline ablation was performed at the most cranial part of the left atrium la with complete conduction block demonstrated during la appendage pacing by the online mapping of continuous double potential and an activation detour propagating around the pvs to activate caudocranially the posterior wall of the la. Of the several proposed linear lesions only mitral isthmus and roof line ablation remain commonly performed as an adjunct to pulmonary vein isolation in the treatment of atrial fibrillation 2 3. Left atrial tachycardias ats most commonly occur after catheter or surgical ablation of atrial fibrillation and in patients with atrial myopathies.

13 finally a randomized prospective trial comparing segmental pv isolation and circumferential pv ablation plus linear ablation at the la roof and mi showed that significantly. About every fourth patient presenting for catheter ablation of atrial fibrillation af has a persistent foramen ovale pfo. 1 this remnant of the fetal circulation can be used as route to the left atrium la during af ablation obviating the need for a transseptal puncture tsp with its associated risks. Background isolation of the pulmonary veins pvs for the treatment of atrial fibrillation af is often supplemented with linear lesions within the left atrium la.

Atrial fibrillation ablation is a procedure used to treat an irregular heart rhythm arrhythmia that starts in the heart s upper chambers atria. It has been suggested that ablation lines along the roof of the la and mitral isthmus may improve clinical outcomes in paf. That is doctors may make a lesion line along the roof of the left atrium and then pace or use a mapping catheter to determine whether conduction has been stopped.