Acute left atrial ridge lesion after cryoballoon ablation: How it
affects left atrial appendage closure combined procedure?
Abstract
Background: Acute left atrial ridge (LAR) lesion was observed after
atrial fibrillation ablation. However, the feature of LAR lesion has not
been quantitatively evaluated and its influence on left atrial appendage
closure (LAAC) combined procedure remained to be explored. We aimed to
evaluate profile of acute LAR lesion and investigate its influence on
LAAC procedure. Methods: LAR lesion profile was measured by
transesophageal echocardiography (TEE) in 117 consecutive non-valvular
AF patients underwent combined procedure of cryoballoon (CB) ablation
and LAAC. Its correlation with baseline variables and clinical outcomes
were thoroughly investigated. Results: Measurement of 96 available TEE
image series showed 95 had prominent acute LAR lesion, with a greater
change in width (Δwidth=3.6±2.3 mm) than thickness (Δthickness=2.6±3.5
mm), and correspondingly narrowed outer ostium (Δouter ostium
diameter=-3.4±4.0 mm). While the inner ostium stayed unchanged. Logistic
regression analysis showed that a higher nadir temperature when freezing
left superior pulmonary vein (LSPV) led to a LAR lesion with greater
width (2-fold wider) (adjusted odds ratio =1.16, 95% confidence
interval 1.02-1.31). For evaluation of LAAC outcomes, residual flow
occurred in 6 patients, 4 with Watchman had minimal residual flow at the
inferior border, while 2 with LAmbre developed larger residual flow at
the LAR side. Clinical outcomes were similar between groups divided by
LAR lesion size. Conclusion: Acute LAR lesion frequently occurred
following CB ablation combined procedure, and its width positively
correlates with LSPV nadir temperature. It affects measurement of
pacifier device but has no influence on plug device when performing
combined procedure.