Procedural aspects and clinical outcome after posterior wall isolation in an atrial fibrillation patient cohort: a retrospective single-center study.

H. Igelmann (Oldenburg)¹, C. Meinhardt (Oldenburg)², S. Au (Oldenburg)¹, B. Schrader (Oldenburg)¹, A. Elsässer (Oldenburg)¹, P. Halbfaß (Oldenburg)^1
1Klinikum Oldenburg AöR Klinik für Kardiologie Oldenburg, Deutschland; ²Klinikum Oldenburg AöR Universitätsklinik für Innere Medizin – Gastroenterologie, Hepatologie, Stoffwechselmedizin mit Sektion für Nieren- und Hochdruckerkrankungen Oldenburg, Deutschland

Aim: To evaluate acute and long-term efficacy and safety of posterior wall isolation in
addition to pulmonary vein isolation using high power short duration radiofrequency ablation
in atrial fibrillation patients.

Methods and Results: Consecutive atrial fibrillation (AF) patients undergoing a first or redo
AF catheter-ablation including posterior wall isolation from March 2021 to July 2023 at our
EP center were included in this retrospective single-center analysis. All procedures were
performed using a 3D electro-anatomical mapping system (Carto 3, Biosense Webster) with
an irrigated ablation catheter with contact force measurement. In all patients an esophageal
endoscopy was performed 1 to 3 days after catheter-ablation in order to exclude or identify
ablation-induced esophageal lesions.
In total 60 of 570 patients (71±8 years; 40% male; 68% paroxysmal AF) undergoing catheter
ablation for atrial fibrillation received left atrial posterior wall isolation in addition to PVI.
Eight of 60 patients (15%) received a redo procedure including re-isolation of posterior wall
in 3 patients. In 5 of 8 patients, all pulmonary veins and LA posterior wall were still isolated.
An endoscopically detected esophageal lesion (EDEL) was detected in 6 of 60 (10%) patients
(EDEL category 1). In none of the patients any clinically relevant esophageal complications
were detected. After a mean follow-up of 1.4 years 34 of 60 (57%) patients were free of atrial
fibrillation or atrial tachycardia. A delayed-onset pericardial tamponade occurred in one
patient on the day after the procedure (successful drainage).

Conclusion: Posterior wall isolation in addition to PVI in patients with pre-existing complete
PV isolation in a redo procedure or relevant posterior wall substrate using high power short
duration ablation resulted in a 10% incidence of EDEL. A moderate long-term success rate of
57% was found in this complex patient cohort.