Impact of anteroinferior transseptal puncture on creation of a complete block at the mitral isthmus in patients with atrial fibrillation

Kenji Okubo, Taishi Kuwahara, Masateru Takigawa, Yasuaki Tanaka, Jun Nakajima, Yuji Watari, Emiko Nakashima, Kazuya Yamao, Yuichiro Sagawa, Katsumasa Takagi, Tadashi Fujino, Hiroyuki Tsutsui, Atsushi Takahashi

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3 Citations (Scopus)

Abstract

Purpose: Achieving complete mitral isthmus (MI) conduction block for atrial fibrillation (AF) ablation remains challenging. We hypothesized that transseptal puncture (TSP) at the anteroinferior aspect of the atrial septum (anteroinferior TSP) could shorten the distance to the MI and improve catheter contact and stability, enabling complete MI block. This study investigated the efficacy of anteroinferior TSP for MI ablation in AF patients. Methods: Three hundred and twenty consecutive patients (mean age: 62 ± 9 years, 84 % male) with persistent AF undergoing AF ablation, including MI ablation, were enrolled. MI ablation was performed through the conventional (posterior) TSP site (group C, n = 170) or the anteroinferior TSP site (group A, n = 150). Results: Left atrial diameter (LAD) enlargement was greater in group A than in group C (45.8 ± 5.3 mm vs. 44.1 ± 5.0 mm, p = 0.002). Complete MI block at the initial session was significantly higher in group A than in group C (141/150 [94 %] vs. 144/170 [85 %], p = 0.011). At the repeat session for AF recurrence, the rate of persistent complete MI block was significantly higher in group A than in group C (36/48 [75 %] vs. 28/67 [42 %], p < 0.001). LAD (p = 0.011) and left ventricular diastolic dimension (p = 0.037) were significant predictors of failed MI block, while anteroinferior TSP was significantly associated with successful MI block (p < 0.001). Conclusion: Anteroinferior TSP could improve the initial success rate and long-term persistence of complete MI block for AF ablation.

Original languageEnglish
Pages (from-to)317-325
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Volume48
Issue number3
DOIs
Publication statusPublished - Apr 1 2017
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Okubo, K., Kuwahara, T., Takigawa, M., Tanaka, Y., Nakajima, J., Watari, Y., Nakashima, E., Yamao, K., Sagawa, Y., Takagi, K., Fujino, T., Tsutsui, H., & Takahashi, A. (2017). Impact of anteroinferior transseptal puncture on creation of a complete block at the mitral isthmus in patients with atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 48(3), 317-325. https://doi.org/10.1007/s10840-016-0203-9