Symposium on epicardial approach to posterior cardiac ablation convened at Heart Rhythm 2012


Electrophysiology thought leaders gathered to discuss the significance of posterior ablation in the treatment of arrhythmias, with presentations highlighting the importance of isolating the posterior left atrium with an adjunctive epicardial treatment. The symposium was supported by nContactand held in conjunction with Heart Rhythm 2012, the Heart Rhythm Society’s 33rd Annual Scientific Sessions, in Boston, USA, on 8 May.

Titled “Relevance and significance of posterior cardiac ablation,” the event explored how epicardial ablation, under direct endoscopic visibility and without chest incisions, can create posterior isolation, which may have clinical impact. It was moderated by James McKinnie, associate professor of Clinical Medicine, Tulane University and chief cardiac electrophysiologist at East Jefferson General Hospital, Metairie, USA.

McKinnie commented: “Clinical experience demonstrates that epicardial ablation can achieve complete, transmural lesions on the posterior of the heart more effectively than endocardial ablation alone. While the invasiveness of epicardial ablation procedures has historically been a deterrent, new minimally invasive approaches, without chest incisions, lung deflation or heart dissections, are enabling electrophysiologists to incorporate epicardial ablation into their clinical practices and more adequately attain the critical endpoint of posterior isolation. To date, we are pleased with this adjunctive epicardial ablation therapy and feel it is beneficial to improving clinical practice.”

Kurt Roberts-Thomson, University of Adelaide School of Medicine and Royal Adelaide Hospital, Adelaide, Australia, presented “Impact of atrial remodeling on the posterior left atrium and recurrent arrhythmias”. He said: “Our lab has written profusely on the importance of the posterior wall as the mechanism of atrial fibrillation. The posterior wall has been implicated in the initiation and maintenance of AF and this technology can target sites potentially important in the mechanism of AF.”

Murali Chiravuri, Bridgeport Hospital Yale New Haven Health, Bridgeport, and Danbury Hospital, Danbury, USA, gave a talk on “Mapping after epicardial ablation of the posterior left atrium.” He said: “The great concern for endocardial ablation of the posterior is safety; particularly, collateral tissue damage of the esophagus. Other approaches have tried to create ‘box’ lesion sets to isolate the posterior with limited success, but this is the first approach that lays overlapping lesions across the posterior pulmonary vein extensions. As discussed at the symposium, we are excited to see improved early clinical results and evidence that complete posterior isolation may promote remodeling of diseased hearts and act to improve heart function.”