Lineaire ablatie van de voorwand van het linkeratrium vermindert AF-recidieven bij aorta-inkapseling

<sec><st>Background</st> <p>Mechanical compression from the ascending aorta on the left atrial anterior wall (LAAW) can cause low voltage areas (LVAs), which are associated with a higher risk of atrial fibrillation (AF) recurrence after catheter ablation. This study investigates the AF recurrence rate post-LAAW complex fractionated atrial electrograms (CFAE) ablation or LAAW linear ablation in AF patients with aortic encroachment.</p> </sec> <sec><st>Methods</st> <p>We retrospectively analysed AF patients who underwent first-time ablation between 2019 and 2023 in our department and had preablation cardiac CT scans. The impact of LAAW-LVAs and different LAAW ablation strategies on AF recurrence within 1-year postprocedure was evaluated.</p> </sec> <sec><st>Results</st> <p>In total, 267 patients had both aortic encroachment and LAAW-LVAs. In the absence of LAAW ablation, patients with aortic encroachment had a significantly higher risk of AF recurrence compared with those without (adjusted HR (aHR): 2.29, 95% CI: 1.27 to 4.15, p=0.006). Patients receiving LAAW CFAE ablation had a higher recurrence rate than those receiving LAAW linear ablation (aHR: 3.29, 95% CI 1.42 to 7.63, p=0.006). Multivariable analysis identified that LAAW linear ablation was a strong independent predictor of reduced AF recurrence (HR: 0.13, 95% CI 0.06 to 0.28, p&lt;0.001).</p> </sec> <sec><st>Conclusions</st> <p>Aortic encroachment is a common and significant risk factor for AF recurrence after ablation. When LAAW-LVAs are present, performing LAAW linear ablation might be a highly effective strategy to reduce postablation AF recurrence.</p> </sec>