Left Atrial Roof Line

A left atrial isthmus was first described by luria et al.

Left atrial roof line.

Technique for ablation of the left atrial roof the la roofline is a line of lesions joining the left and right superior pvs. An irrigated ablation catheter is introduced with its tip oriented toward the la roof. Surface electrocardiographic criteria to differentiate it from mitral annular ma flutters are lacking. A left atrial la line monitors left atrial pressures acting as a surrogate for left ventricular function preload and afterload.

As a result of greater extension of atrial fibrosis 5 for this reason the creation of additional linear lesions in the left atrium la has been proposed. These lines include the la roof the posterior line and the mitral isthmus 6 12 still the role of additional lines remains controversial. The left atrial line is a single lumen catheter unlike the right atrial line which is double lumen. Addition of linear ablation lesions principally in the atrial roof between the left and right superior pulmonary veins and mitral isthmus between the left inferior pulmonary vein and the mitral annulus led to improved success rates especially in patients with paroxysmal af and coexistent la enlargement and in patients with persistent af.

The clinical at was a dual loop at with left atrial la roof dependent and anterior macro re entrant circuits and terminated by an la roof and left superior pv mitral annulus linear ablation. Techniques evaluation and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation. Left atrial la roof dependent flutter is a common macroreentrant la tachycardia that involves the la roof and typically spins around ipsilateral pulmonary veins pvs. It is sometimes called sequential ablation because the additional ablation lines are performed in a specified order.

If there continues to be afib activity the doctor will ablate the next area in the sequence. Of the several proposed linear lesions only mitral isthmus and roof line ablation remain commonly performed as an adjunct to pulmonary vein isolation in the treatment of atrial fibrillation 2 3. The left atrial line enters from the left superior pulmonary vein and exits the far side of the chest. They described the phenomenon of intra atrial conduction block in a subset of patients undergoing ablation for left lateral accessory pathways.

Isolation of the pulmonary veins pvs for the treatment of atrial fibrillation af is often supplemented with linear lesions within the left atrium la. That is doctors may make a lesion line along the roof of the left atrium and then pace or use a mapping catheter to determine whether conduction has been stopped. A prospective randomized study.