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AF ablation: A single operator s experience over 3 years 2007 2009

Background. Inconsistent results of AF ablation? Due to Heterogeneity amongst AF populationRole of Trigger removal vs Substrate modification. Hypotheses. Substrate modification can be achieved with linear lesionsIncremental lesion set depending upon disease stageIndividualised approach may standardise single procedure success rates across AF population? Safety and feasibility of this approach.

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AF ablation: A single operator s experience over 3 years 2007 2009

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    1. AF ablation: A single operator’s experience over 3 years (2007 – 2009) Barker D, Patwala A, Damm E, Hall M, Snowdon R, Gupta D Liverpool Heart and Chest Hospital, UK

    3. Hypotheses Substrate modification can be achieved with linear lesions Incremental lesion set depending upon disease stage Individualised approach may standardise single procedure success rates across AF population ? Safety and feasibility of this approach

    4. Methods: Definition of AF groups 131 consecutive patients coming for AF ablation (DG) Sustained PAF: Patients with PAF, with = 2 of Any individual AF episodes > 24 hours History of AF > 5 years LA size on Echo > 4.5 cm Age > 65 years Documented flutter True PAF Persistent AF (> 7 days/ Needed Cardioversion) Longstanding Persistent AF (>12 months)

    6. Methods: Prescribed lesion set True PAF: PVAI Sustained PAF: + LA roof line + RA flutter line Persistent AF: + LA floor line LS Persistent AF: + Epicardial CS ablation + LA septal ablation + CFEs at LAA os

    11. Follow-up strategy AAD therapy continued for 2/3 months Clinic and ECG review at least every 3 months HRN Contact Line for inter-current support Ambulatory monitoring to assess symptoms Early post-op arrhythmias DC CV if sustained and poorly tolerated Redo ablation deferred for at least 5-6 months

    14. Results: Ablation procedure

    15. Mean Follow up duration

    17. Symptomatic cure – patient satisfaction

    18. 12 month follow up results

    19. Freedom from documented AF/ AT

    20. Follow up

    21. Conclusions Individualised ablation strategy based on incremental linear lesion placement feasible on practical grounds Not associated with greater risk of procedural complications Anatomical (3D mapping based) approach to linear lesion creation associated with acceptably low risk of MAT This strategy may result in some uniformity of results across the spectrum of AF patients

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