Anatomical insights into modified posterior-inferior line in patients
with atrial fibrillation: Implications in left atrial posterior wall
isolation
Abstract
Introduction Left atrial posterior wall (LAPW) isolation may be
performed as an additional atrial fibrillation (AF) ablation strategy
based on pulmonary vein isolation. A modified posterior-inferior line
(MPL) was proposed for reducing esophageal injury. The aim of this study
was to evaluate the anatomical characteristics of the MPL, compared with
the CPL. Methods and Results Multidetector computed tomography was
performed in 102 consecutive AF patients (male/female = 60/42)
preoperative, and the parameters were evaluated as follows: the distance
from MPL and CPL to the esophagus, fat pad presence and thickness in the
course of MPL and CPL, and the esophageal route below CPL. The average
distance from the MPL to the esophagus was longer than from CPL to the
esophagus (3.7 ± 1.5mm vs 1.7 ± 0.4mm, P < 0.001). Fat pad
presence was higher in the course of MPL than CPL. The myocardium tissue
and fat pad under MPL was thicker than under CPL (2.9 ± 1.1mm vs 1.6 ±
0.3mm, P < 0.001; 1.4 ± 0.6mm vs 0.9 ± 0.2mm, P <
0.001), respectively. In patients whose esophagus was unconfined in a
triangular space at the left inferior pulmonary vein level, the average
distance from MPL to esophagus was longer than the confined patients
(4.0 ± 1.7mm vs 3.2 ± 1.0mm, P = 0.001). Conclusion The MPL was far away
from the esophagus with thicker myocardium tissue and more fat pad than
the CPL; thus, MPL could serve as a favorable alternative in linear
ablation for LAPW isolation.