Approaches to Catheter Ablation of Nonparoxysmal Atrial Fibrillation

Bilateral left lateral ridge ablation increases the long-term success of patients ablated for atrial fibrillation

AIMS

Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation in paroxysmal atrial fibrillation (PAF). Studies reported that the PVI single procedure was able to achieve durable sinus rhythm without the need of antiarrhythmic drugs in 60-80% of patients with PAF. In this study, we report data regarding bilateral left lateral ridge ablation for PAF.

METHODS

We retrospectively collected data of 120 consecutive patients (mean age 56 ± 10 years; 62% male) referred to our center to perform PVI. In 60 patients we performed PVI (group 1) and in 60 patients performed PVI and bilateral left lateral ridge ablation (group 2). All patients performed a clinical follow-up after 24 months from the ablation procedure.

RESULTS

PVI was achieved in all patients. The mean radiofrequency time to perform ablation on the left atrial appendage ostium was 216 ± 49 s. In all patients of group 2 we obtained disappearance of local electrograms and the loss of local capture during pacing on posterior wall of left atrial appendage ridge. No significant differences were found between the two groups regarding mean contact force during ablation (14 ± 4 vs. 15 ± 4 g; groups 1 and 2, respectively, P = 0.34). At 24-month follow-up, single procedure success rate was significantly higher in group 2 compared with group 1 (88 vs. 74%, respectively; P = 0.03). No significant procedural complications were documented.

CONCLUSION

Bilateral left lateral ridge ablation is a safe technique able to improve the success rate of PVI in patients with PAF.