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Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions : the ALINE study

Michael Wolf, Milad El Haddad, Joël Fedida, Philippe Taghji, Katarina Van Beeumen, Teresa Strisciuglio, Jan De Pooter (UGent) , Caroline Lepièce, Yves Vandekerckhove, René Tavernier, et al.
(2018) EUROPACE. 20(3). p.f401-f409
Author
Organization
Abstract
Aims: Achieving block across linear lesions is challenging. We prospectively evaluated radiofrequency (RF) linear ablation at the roof and mitral isthmus (MI) using point-by-point contiguous and optimized RF lesions. Methods and results: Forty-one consecutive patients with symptomatic persistent AF underwent stepwise contact force (CF)-guided catheter ablation during ongoing AF. A single linear set of RF lesions was delivered at the roof and posterior MI according to the 'Atrial LINEar' (ALINE) criteria, i.e. point-by-point RF delivery (up to 35W) respecting strict criteria of contiguity (inter-lesion distance <= 6 mm) and indirect lesion depth assessment (ablation index >= 550). We assessed the incidence of bidirectional block across both lines only after restoration of sinus rhythm. After a median RF time of 7 min [interquartile range (IQR) 5-9], first-pass block across roof lines was observed in 38 of 41 (93%) patients. Final bidirectional roof block was achieved in 40 of 41 (98%) patients. First-pass block was observed in 8 of 35 (23%) MI lines, after a median RF time of 8 min (IQR 7-12). Additional endo-and epicardial (54% of patients) RF applications resulted in final bidirectional MI block in 28 of 35 (80%) patients. During a median followup of 396 (IQR 310-442) days, 12 patients underwent repeat procedures, with conduction recovery in 4 of 12 and 5 of 10 previously blocked roof lines and MI lines, respectively. No complications occurred. Conclusion: Anatomical linear ablation using contiguous and optimized RF lesions results in a high rate of first-pass block at the roof but not at the MI. Due to its complex 3D architecture, the MI frequently requires additional endo-and epicardial RF lesions to be blocked.
Keywords
Atrial fibrillation, Catheter ablation, Linear ablation, Roof line, Mitral isthmus line, Contact force, Ablation index, MITRAL ISTHMUS, CATHETER ABLATION, FIBRILLATION, BLOCK

Citation

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MLA
Wolf, Michael, et al. “Evaluation of Left Atrial Linear Ablation Using Contiguous and Optimized Radiofrequency Lesions : The ALINE Study.” EUROPACE, vol. 20, no. 3, 2018, pp. f401–09, doi:10.1093/europace/eux350.
APA
Wolf, M., El Haddad, M., Fedida, J., Taghji, P., Van Beeumen, K., Strisciuglio, T., … Knecht, S. (2018). Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions : the ALINE study. EUROPACE, 20(3), f401–f409. https://doi.org/10.1093/europace/eux350
Chicago author-date
Wolf, Michael, Milad El Haddad, Joël Fedida, Philippe Taghji, Katarina Van Beeumen, Teresa Strisciuglio, Jan De Pooter, et al. 2018. “Evaluation of Left Atrial Linear Ablation Using Contiguous and Optimized Radiofrequency Lesions : The ALINE Study.” EUROPACE 20 (3): f401–9. https://doi.org/10.1093/europace/eux350.
Chicago author-date (all authors)
Wolf, Michael, Milad El Haddad, Joël Fedida, Philippe Taghji, Katarina Van Beeumen, Teresa Strisciuglio, Jan De Pooter, Caroline Lepièce, Yves Vandekerckhove, René Tavernier, Mattias Duytschaever, and Sébastien Knecht. 2018. “Evaluation of Left Atrial Linear Ablation Using Contiguous and Optimized Radiofrequency Lesions : The ALINE Study.” EUROPACE 20 (3): f401–f409. doi:10.1093/europace/eux350.
Vancouver
1.
Wolf M, El Haddad M, Fedida J, Taghji P, Van Beeumen K, Strisciuglio T, et al. Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions : the ALINE study. EUROPACE. 2018;20(3):f401–9.
IEEE
[1]
M. Wolf et al., “Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions : the ALINE study,” EUROPACE, vol. 20, no. 3, pp. f401–f409, 2018.
@article{8600087,
  abstract     = {{Aims: Achieving block across linear lesions is challenging. We prospectively evaluated radiofrequency (RF) linear ablation at the roof and mitral isthmus (MI) using point-by-point contiguous and optimized RF lesions. 
Methods and results: Forty-one consecutive patients with symptomatic persistent AF underwent stepwise contact force (CF)-guided catheter ablation during ongoing AF. A single linear set of RF lesions was delivered at the roof and posterior MI according to the 'Atrial LINEar' (ALINE) criteria, i.e. point-by-point RF delivery (up to 35W) respecting strict criteria of contiguity (inter-lesion distance <= 6 mm) and indirect lesion depth assessment (ablation index >= 550). We assessed the incidence of bidirectional block across both lines only after restoration of sinus rhythm. After a median RF time of 7 min [interquartile range (IQR) 5-9], first-pass block across roof lines was observed in 38 of 41 (93%) patients. Final bidirectional roof block was achieved in 40 of 41 (98%) patients. First-pass block was observed in 8 of 35 (23%) MI lines, after a median RF time of 8 min (IQR 7-12). Additional endo-and epicardial (54% of patients) RF applications resulted in final bidirectional MI block in 28 of 35 (80%) patients. During a median followup of 396 (IQR 310-442) days, 12 patients underwent repeat procedures, with conduction recovery in 4 of 12 and 5 of 10 previously blocked roof lines and MI lines, respectively. No complications occurred. 
Conclusion: Anatomical linear ablation using contiguous and optimized RF lesions results in a high rate of first-pass block at the roof but not at the MI. Due to its complex 3D architecture, the MI frequently requires additional endo-and epicardial RF lesions to be blocked.}},
  author       = {{Wolf, Michael and El Haddad, Milad and Fedida, Joël and Taghji, Philippe and Van Beeumen, Katarina and Strisciuglio, Teresa and De Pooter, Jan and Lepièce, Caroline and Vandekerckhove, Yves and Tavernier, René and Duytschaever, Mattias and Knecht, Sébastien}},
  issn         = {{1099-5129}},
  journal      = {{EUROPACE}},
  keywords     = {{Atrial fibrillation,Catheter ablation,Linear ablation,Roof line,Mitral isthmus line,Contact force,Ablation index,MITRAL ISTHMUS,CATHETER ABLATION,FIBRILLATION,BLOCK}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{f401--f409}},
  title        = {{Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions : the ALINE study}},
  url          = {{http://dx.doi.org/10.1093/europace/eux350}},
  volume       = {{20}},
  year         = {{2018}},
}
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