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How to do a Roof Line and Prove Block

How to do a Roof Line and Prove Block. Dhiraj Gupta Liverpool Heart and Chest Hospital. Schema. Why? Where? How?. 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

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How to do a Roof Line and Prove Block

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  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

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

  9. Roof Line in AF

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

  11. ‘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

  12. True PAF Sustained PAF

  13. Persistent AF Long-standing PsAF

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

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

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