Posterior wall isolation using a novel radiofrequency ablation catheter—an addition to our atrial fibrillation armamentarium

Excerpt

Atrial fibrillation (AF) remains the most common arrhythmia plaguing patients worldwide. Despite the remarkable advances in catheter ablation, achieving long-term success in patients with non-paroxysmal AF remains challenging. The left atrial posterior wall (PW) has recently gained traction as an additional target to improve AF ablation outcomes in this cohort. Embryologically, the pulmonary veins (PVs) unite to form a common antrum that joins the left atrial appendage (remnant of the primordial left atrium) and the area around the mitral annulus to form the left atrium [1]. The PW and PVs are histologically indistinguishable, representing an amalgam of atrial myocardium and primary venous components [1]. This, along with other factors like heterogenous fiber orientation, frequent fibrosis, and cellular properties which make the PW susceptible to misfiring, as mentioned by the authors [2] became the impetus to consider posterior wall isolation (PWI) as an adjunct to pulmonary vein isolation (PVI) in AF ablation. Several approaches have been conceived to isolate the PW, including endocardial box isolation, single ring isolation, debulking, and hybrid surgical and endocardial ablation. …