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Posterior Wall Isolationfor Atrial Fibrillation: Effects on Echocardiographic Parameters Of Cardiac Function

Background: Posterior wall isolation(PWI)in addition to circumferential pulmonary vein isolation (CPVA) requires more ablation of left atrial tissue. We compared the effect of PWI versus non-PWI methods (CPVA + linear lesions) on echocardiographic parameters of left atrial and left ventricular function. Methods: We selected patients who had pre and post ablation echocardiogram at our institution.Parameters assessed were: Left ventricular outflow tract velocity time integral (VTI), left ventricular ejection fraction (LVEF), atrial Doppler velocity across mitral valve (A), E/E’, and deceleration time. Results: Of the 72 patients studied, 32.5% had PWA in addition to CPVA. The mean duration between echocardiograms was 650 + 542 days. PWA group had an average postoperative VTI 0.21 + 0.05 vs 0.21 + 0.05 in the non-PWA (p=0.61) group. Average improvement compared to pre ablation parameters: VTI was 0.03 + 0.06 vs 0.008 + 0.05 (p=0.17), postoperative A was 0.49 + 0.19 vs 0.57 + 0.19 (p=0.16), postoperative LVEF was 57.5 + 9.9% vs 57.8 + 10.8 % (p=0.89), with average change in LVEF 1.5 ± 7.8 vs 0.86 ± 9.7 (p=0.78) in PWA and non-PWA groups respectively. There was no significant difference in change in deceleration time or E/E’ when comparing the two groups. Conclusion: PWA did not adversely affect echocardiographic parameters of left atrial function or left ventricular systolic or diastolic function when compared to other types of ablation.

Credits: Xin Zhang MD, Neil Beri MD, Pankaj Malhotra MD, Rakhee Makhija MBBS, Eric Nordsieck MD, Adam Oesterle MD, Dali Fan MD, NayerehPezeshkian MD FHRS, Uma Srivatsa MBBS FHRS

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