Adjunctive percutaneous ablation targeting epicardial arrhythmogenic structures in patients of atrial fibrillation...

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Recurrent atrial fibrillation (AF) after multiple ablation procedures presents a significant clinical challenge.
• Identifying and treating epicardial arrhythmogenic substrates is crucial for managing refractory AF.

Purpose of the Study:

• To evaluate the efficacy of adjunctive epicardial ablation for epicardial arrhythmogenic substrates in patients with recurrent AF after multiple prior ablation procedures.
• To assess the safety and outcomes of a percutaneous epicardial approach in this challenging patient cohort.

Main Methods:

• A prospective study involving 35 patients with recurrent AF/atrial tachycardia (AT) and at least two prior ablations.
• Percutaneous epicardial mapping and ablation were performed via subxiphoid access, complementing standard endocardial procedures.
• Specific targets included the left lateral ridge (LLR), Marshall Bundle (MB), and Bachmann's bundle (BB), along with epicardial triggers.

Main Results:

• Adjunctive epicardial ablation, particularly for LLR, was performed in 88.6% of patients, achieving efficient transmural lesions.
• Epicardial ablation successfully addressed MB potentials in three patients and conduction gaps in the BB in four patients.
• Two epicardial AT/AF triggers were identified and successfully eliminated.
• No periprocedural complications were reported.
• Freedom from AF/AT was achieved in 65.7% of patients at a mean follow-up of 23.2 months.

Conclusions:

• Percutaneous epicardial mapping and ablation is a viable strategy for patients with multiple failed AF ablation procedures.
• Targeting epicardial substrates like LLR, MB, and BB, in addition to endocardial ablation, can improve success rates.
• This approach offers a potential solution for refractory AF cases unresponsive to conventional therapies.