How to do a Roof Line and Prove Block Dhiraj Gupta Liverpool Heart and Chest Hospital.

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Presentation transcript:

How to do a Roof Line and Prove Block Dhiraj Gupta Liverpool Heart and Chest Hospital

Schema Why? Where? How?

Why? Critical in substrate modification in Persistent AF Haissaguerre et al JCE 2005;16: Improved results in Paroxysmal AF Hocini et al Circ 2005; 112: A more individualized strategy?

Where? Transverse line between septal & lateral veins Roof is the shortest distance

LA-Esophagus relationship

How? Need anchors on either side Both upper PVs need to be isolated first! Aims Immediate: get contiguous transmural lesions Final: Conduction detour In Sinus/ AF

Roof Line in Sinus Rhythm

How to prove block? LAA pacing: Hocini et al Circ 2005; 112: Sinus Rhythm: Sang et al, JCE 2010; 21: 741-6

Roof Line in AF

Our experience Oral presentation at Cardiostim, Nice June 2010

‘Sustained PAF’ Patients with PAF, with ≥2 of Any individual AF episodes>24 hours Mod/ Severe LA enlargement (>4.5 cm) Age >65 years Long History of AF (> 5 years) Documented flutter True PAF

Sustained PAF

Persistent AFLong-standing PsAF

194 patients 138 Roof Lines Average Procedure time: minutes No acute complication 2 roof dependent flutters on follow-up Sep 2008-Sep 2010

Conclusions LA roof line often the first step in substrate modification ‘Easiest’ linear lesion to create Caudocranial activation of the posterior wall confirms block