Left atrial anterior scar in persistent atrial fibrillation: Results with pulmonary vein isolation and linear ablation including posterior mitral line.

BACKGROUND

The anatomic ablation set that comprises pulmonary vein isolation, roof line, posterior mitral line with vein of Marshall alcohol ablation, and cavotricuspid isthmus line spares the anterior wall to preserve left atrial (LA) physiology. The outcome of patients with persistent atrial fibrillation (AF) and spontaneous LA anterior scar ablated with this strategy is not known.

OBJECTIVE

This study aimed to evaluate patients presenting with spontaneous LA anterior scar and persistent AF in terms of clinical characteristics and ablation outcome using this ablation set.

METHODS

Patients with persistent AF referred for AF ablation from June 2018 to June 2023 were screened. Patients presenting spontaneous LA anterior scar were compared with patients with no scar. The ablation strategy consisted of pulmonary vein isolation, vein of Marshall alcohol ablation, roof line, posterior mitral line, and cavotricuspid isthmus line.

RESULTS

111 consecutive patients were evaluated: 35 patients in the scar group (SCAR group) and 76 patients in the control group. After propensity weighting, the population resulted in 101 patients: 34 patients in the SCAR group and 67 patients in the control group. There were significantly more female patients in the SCAR group (18 [23.4%] vs 20 [69%]; P < .001). The mean follow-up was 17 ± 11 months. The lesion set could be accomplished in all. After a first procedure, the AT-AF-free survival was significantly lower in the SCAR group (82.9% vs 65.7%; P = .005).

CONCLUSION

After a Marshall-plan ablation procedure, the presence of spontaneous LA anterior scar is associated with more AT/AF recurrence during the follow-up. These results suggest that additional ablation may be necessary to complement the initial ablation set during the first procedure in these patients.