Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent...

Area of Science:

• Electrophysiology
• Cardiac Arrhythmias
• Medical Devices

Background:

• Left atrial appendage electrical isolation (LAAEI) shows promise for atrial fibrillation (AF) freedom.
• Spectral analysis can identify high-frequency sources driving AF.
• The specific impact of LAAEI on AF dynamics in long-standing persistent AF (LSPAF) remains unclear.

Purpose of the Study:

• To investigate the effect of LAAEI on atrial dominant frequency (DF) in patients with LSPAF.
• To determine if LAAEI benefits specific LSPAF patient subgroups.

Main Methods:

• Twenty patients with LSPAF underwent electrogram recordings from 13 atrial sites.
• Fast Fourier transforms (FFT) were used to calculate DF.
• Stepwise ablation included pulmonary vein isolation, mitral isthmus, and roof lines, with LAAEI added in some cases.

Main Results:

• Stepwise ablation significantly reduced DF in the coronary sinus and left atrial posterior wall (LApos).
• LAAEI further decreased DF specifically at the LApos.
• A <13.6% DF reduction in LApos post-stepwise ablation, when LAAEI was added, correlated with increased sinus rhythm restoration (55%).

Conclusions:

• LAAEI, combined with stepwise ablation, further reduces LApos DF.
• This DF reduction is associated with acute AF termination and improved ablation outcomes in LSPAF patients.