Background: Left atrial posterior wall isolation (LAPWI) has been proved to be beneficial in long standing persistent atrial fibrillation (AF). This study aims to assess the accuracy of oesophageal pacing catheters to detect reconnection at a time point during long-term follow-up remote from the isolation procedure.
Method: This is a prospective study and includes patients who underwent ablation therapy (catheter or hybrid) for long standing persistent AF, where LAPWI was judged to have been achieved based on surgical or catheter ablation criteria. Patients underwent oesophageal pacing and recording at an interval greater than 6 weeks following initial ablation. Subsequent to this, all patients underwent a left atrial electrophysiology (EP) study to confirm or refute findings from the oesophageal study.
Results: In 20 out of 21 patients studied, the oesophageal catheter study correlated with the invasive EP study. The negative predictive value of this test is 95.00 % (95% CI of 74.29% to 99.92%), where a negative result is being unable to capture the atrial rhythm by oesophageal pacing indicating that the LAPW remains isolated. The positive predictive value is 100%, where a positive finding indicates being able to capture the atrial rhythm by oesophageal pacing indicating that the LAPW has reconnected.
Conclusions: We were able to demonstrate that oesophageal pacing catheters can successfully be used for verification of LAPWI. This is important in assessment of the long-term efficacy of LAPWI and also in informing operators of the durability of the results they are achieving by either catheter or surgical ablation.
Credits: Nitin Chandra Mohan, Guy A Haywood