12/27/2023 0 Comments Cpt code of atrial flutter ablationFurthermore, attempts to improve endocardial lesion depth and durability with higher power, force, or duration may increase procedural risks, including injury to periesophageal branches of vagus nerve and esophageal injury such as atrioesophageal fistula.Ĭombined Epicardial Endocardial Ablation: Hybrid Convergent Procedureĭue to these challenges, a hybrid approach combining epicardial and endocardial ablation was introduced. The lack of a standardized lesion set, challenges of achieving transmural lesions, and endocardial/epicardial dissociation in AF together contribute to limited effectiveness of endocardial posterior wall isolation. Despite high acute success, substantial rates of posterior wall reconnections have been reported at repeat electrophysiology procedures, indicating difficulty in creating transmural and durable lesions. 14Ĭhallenges With Endocardial Ablation of Posterior Wallĭue to increasing evidence that the posterior wall provides substrate for maintaining AF, endocardial ablation of the posterior wall has been explored. 11-13 Another phenomenon that occurs as a result of progressive structural remodeling is dissociation of epicardial and endocardial activation patterns, allowing fibrillation waves to propagate between epicardium and endocardium, further adding to fibrillatory conduction. 8-10 Increased pressure and LA dilation due to prolonged AF cause stretching and inflammation, leading to fibrosis, which contributes to micro-re-entry. 7 The posterior wall shares tissue origin with the PVs and has unique electrophysiological characteristics (i.e., short refractory period and high density of autonomic neurons), all of which contribute to initiation and maintenance of AF. 5-7 The LA posterior wall has been shown to have the highest proportion of non-PV triggers and is the most common site for AF re-entrant drivers. In patients with advanced AF, the extra-PV triggers drive and sustain AF. LA Posterior Wall: Substrate for Sustaining AF 1,2 Although pulmonary vein (PV) isolation is effective in treating paroxysmal AF, its effectiveness for treatment of persistent forms of AF is limited due to atrial remodeling and increased left atrial (LA) size that occur as AF progresses. Approximately 70% of these people have either persistent or long-standing persistent AF. A heart team approach (i.e., collaboration between electrophysiologists and cardiac surgeons) helps improve outcomes in patients with advanced AF.ĪF affects 33 million people worldwide.
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