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

2. Schema Why? Where? How?

3. Why? Critical in substrate modification in Persistent AF Haissaguerre et al JCE 2005;16:1125-37 Improved results in Paroxysmal AF Hocini et al Circ 2005; 112:3688-96 A more individualized strategy?

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

5. LA-Esophagus relationship

6. 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

7. Roof Line in Sinus Rhythm

20. How to prove block? LAA pacing: Hocini et al Circ 2005; 112:3688-96 Sinus Rhythm: Sang et al, JCE 2010; 21: 741-6

27. Roof Line in AF

30. Our experience Oral presentation at Cardiostim, Nice June 2010

31. ‘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

32. Sustained PAF

33. Persistent AFLong-standing PsAF

34. 194 patients 138 Roof Lines Average Procedure time: 10-15 minutes No acute complication 2 roof dependent flutters on follow-up Sep 2008-Sep 2010

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