LAAW linear ablation significantly reduces AF recurrence compared to LAAW CFAE ablation in patients with aortic encroachment.
Cohort (n=267)
No
Does left atrial anterior wall (LAAW) linear ablation reduce atrial fibrillation recurrence compared to CFAE ablation or no LAAW ablation in patients with aortic encroachment and LAAW low voltage areas?
In patients with atrial fibrillation and aortic encroachment, performing left atrial anterior wall linear ablation significantly reduces the risk of post-ablation AF recurrence.
Effect estimate: HR 3.29 (95% CI 1.42 to 7.63)
Absolute Event Rate: 9.1% vs 25.5%
p-value: p=0.006
Background Mechanical compression from the ascending aorta on the left atrial anterior wall (LAAW) can cause low voltage areas (LVAs), which are associated with a higher risk of atrial fibrillation (AF) recurrence after catheter ablation. This study investigates the AF recurrence rate post-LAAW complex fractionated atrial electrograms (CFAE) ablation or LAAW linear ablation in AF patients with aortic encroachment. Methods We retrospectively analysed AF patients who underwent first-time ablation between 2019 and 2023 in our department and had preablation cardiac CT scans. The impact of LAAW-LVAs and different LAAW ablation strategies on AF recurrence within 1-year postprocedure was evaluated. Results In total, 267 patients had both aortic encroachment and LAAW-LVAs. In the absence of LAAW ablation, patients with aortic encroachment had a significantly higher risk of AF recurrence compared with those without (adjusted HR (aHR): 2.29, 95% CI: 1.27 to 4.15, p=0.006). Patients receiving LAAW CFAE ablation had a higher recurrence rate than those receiving LAAW linear ablation (aHR: 3.29, 95% CI 1.42 to 7.63, p=0.006). Multivariable analysis identified that LAAW linear ablation was a strong independent predictor of reduced AF recurrence (HR: 0.13, 95% CI 0.06 to 0.28, p<0.001). Conclusions Aortic encroachment is a common and significant risk factor for AF recurrence after ablation. When LAAW-LVAs are present, performing LAAW linear ablation might be a highly effective strategy to reduce postablation AF recurrence.
Zhang et al. (Thu,) conducted a cohort in Atrial Fibrillation (n=267). Left atrial anterior wall ablation vs. No ablation was evaluated on AF recurrence rate post-ablation (HR 3.29, 95% CI 1.42 to 7.63, p=0.006). LAAW linear ablation significantly reduces AF recurrence compared to LAAW CFAE ablation in patients with aortic encroachment.